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General NPI Number Information
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NPI Number | 1477561843
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Entity Type | Individual
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Provider Name | DANIEL JASON IRIZARRY M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 05/07/2018
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Provider Practice Location Address
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Address Line | 460 E ALTAMONTE DR STE 2200
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-4653
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Country | US
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Telephone | 407-767-0009
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Fax | 407-767-0022
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Provider Business Mailing Address
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Address Line | 13546 PHOENIX DR
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City | ORLANDO
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State | FL
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Zip | 32828-9340
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Country | US
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Telephone | 407-494-8154
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 00022499
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License Number State | AL
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