MEDICARE: JOSEPH C DALEY III MD FCCP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	ME88922	FL

General Provider Information

NPI Number	:	1528552494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH C DALEY III MD FCCP LLC

Provider Business Mailing Address
First Line	:	1031 SE 9TH PL UNIT 2
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1031 SE 9TH PL UNIT 2
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3003
Country	:	US
Telephone Number	:	239-574-2644
Fax Number	:	866-908-1231

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOSEPH C DALEY III
Credential	:	MD
Telephone Number	:	239-560-8733

Provider Enumeration Date	:	06/14/2018
Last Update Date	:	06/14/2018

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