Healthcare Provider Details

I. General information

NPI: 1679539233
Provider Name (Legal Business Name): DANIEL ISRAEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 10/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1981 PARKWAY
PIGEON FORGE TN
37863-4904
US

IV. Provider business mailing address

1981 PARKWAY
PIGEON FORGE TN
37863-4904
US

V. Phone/Fax

Practice location:
  • Phone: 865-453-1122
  • Fax: 865-453-9754
Mailing address:
  • Phone: 865-453-1122
  • Fax: 865-453-9754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15345
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: