Healthcare Provider Details

I. General information

NPI: 1083683189
Provider Name (Legal Business Name): PATRICK JOSEPH DAIGLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 EMERALD DR STE 7
EMERALD ISLE NC
28594-2880
US

IV. Provider business mailing address

7901 EMERALD DR STE 7
EMERALD ISLE NC
28594-2880
US

V. Phone/Fax

Practice location:
  • Phone: 252-354-6500
  • Fax: 252-354-5060
Mailing address:
  • Phone: 252-354-6500
  • Fax: 252-354-5060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2016-01350
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0074905
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL017247
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: