Healthcare Provider Details

I. General information

NPI: 1821076431
Provider Name (Legal Business Name): DANIEL A ROSSIGNOL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 DAIRY RD
WEST MELBOURNE FL
32904-5210
US

IV. Provider business mailing address

2340 DAIRY RD
WEST MELBOURNE FL
32904-5210
US

V. Phone/Fax

Practice location:
  • Phone: 321-259-7111
  • Fax: 949-407-7652
Mailing address:
  • Phone: 321-259-7111
  • Fax: 949-407-7652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101058228
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME97209
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC54759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: