Healthcare Provider Details

I. General information

NPI: 1104800291
Provider Name (Legal Business Name): JULIET MARIE DANIEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 IRELAND AVE IRELAND ARMY COMMUNITY HOSPITAL
FORT KNOX KY
40121-5111
US

IV. Provider business mailing address

289 IRELAND AVE IRELAND ARMY COMMUNITY HOSPITAL
FORT KNOX KY
40121-5111
US

V. Phone/Fax

Practice location:
  • Phone: 502-624-9906
  • Fax:
Mailing address:
  • Phone: 502-624-9906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD063174L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: