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General NPI Number Information
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NPI Number | 1598015398
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Entity Type | Organization
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Legal Business Name | DALE R TRAFICANTE MD PA
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 07/17/2013
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Provider Practice Location Address
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Address Line | 1890 LPGA BLVD SUITE 220
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-7138
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Country | US
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Telephone | 386-274-5757
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Fax | 386-274-1992
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Provider Business Mailing Address
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Address Line | 1890 LPGA BLVD SUITE 220
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-7138
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Country | US
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Telephone | 386-274-5757
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Fax | 386-274-1992
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Authorized Official
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Title or Position | OWNER
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Name | DR. DALE ROBERT TRAFICANTE
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Credential | MD
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Telephone | 386-274-5757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | ME75370
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License Number State | FL
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