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General NPI Number Information
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NPI Number | 1104454040
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Entity Type | Individual
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Provider Name | DANIEL OLUWADARE ESAN DO
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Gender | Male
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Dates
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Enumeration Date | 03/27/2020
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 4953 VAN DYKE RD
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City | LUTZ
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State | FL
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Zip | 33558-4813
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Country | US
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Telephone | 813-544-8719
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Fax |
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Provider Business Mailing Address
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Address Line | 1102 BRIGADOON DR
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City | CLEARWATER
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State | FL
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Zip | 33759-2931
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Country | US
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Telephone | 443-985-7214
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | OS18082
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License Number State | FL
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