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General NPI Number Information
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NPI Number | 1669979837
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Entity Type | Individual
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Provider Name | DANIEL STEPHEN DEMICK MD
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Gender | Male
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Dates
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Enumeration Date | 04/12/2018
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 740 MACE RD
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City | PATRICK AFB
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State | FL
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Zip | 32925-3616
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Country | US
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Telephone | 304-691-1500
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Fax | 304-523-4358
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Provider Business Mailing Address
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Address Line | 105 KRISTI DR
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City | INDIAN HARBOUR BEACH
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State | FL
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Zip | 32937-4106
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Country | US
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Telephone | 740-649-6147
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D0104452
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME170501
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License Number State | FL
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