Healthcare Provider Details

I. General information

NPI: 1346380136
Provider Name (Legal Business Name): DANIEL PATRICK CONLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 WOODLAND AVE
ST AUGUSTINE FL
32080-6333
US

IV. Provider business mailing address

120 HEALTH PARK BLVD SUITE 1
ST AUGUSTINE FL
32086-3701
US

V. Phone/Fax

Practice location:
  • Phone: 904-471-1526
  • Fax:
Mailing address:
  • Phone: 904-823-3401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0041467
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: