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General NPI Number Information
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NPI Number | 1821089806
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Entity Type | Individual
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Provider Name | MARC LAURENCE DAYMUDE M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 01/29/2014
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Provider Practice Location Address
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Address Line | BROOKE ARMY MEDICAL CENTER, MCHE-QD/CREDENTIALS 3851 ROGER BROOKE DR.
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-6200
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Country | US
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Telephone | 210-916-4626
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Fax | 210-916-2265
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Provider Business Mailing Address
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Address Line | BROOKE ARMY MEDICAL CENTER, MCHE-QD/CREDENTIALS 3851 ROGER BROOKE DR.
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-6200
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Country | US
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Telephone | 210-916-4626
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Fax | 210-916-2265
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 9600332
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License Number State | NC
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