MEDICARE: DR. DANIEL A VINCENT JR. MD, FACS

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	207Y00000X	Otolaryngology Physician	ME 75546	FL
2	207Y00000X	Otolaryngology Physician	ME75546	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740282623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL A VINCENT JR. MD, FACS

Provider Business Mailing Address
First Line	:	SELECT PHYSICIANS ALLIANCE
Second Line	:	10002 PRINCESS PALM AVE. STE 332
City	:	TAMPA
State	:	FL
Zip	:	33619-8327
Country	:	US
Telephone Number	:	813-571-7184
Fax Number	:	813-654-4695

Provider Business Practice Location Address
First Line	:	FLORIDA ENT & ALLERGY
Second Line	:	3006 AZEELE ST
City	:	TAMPA
State	:	FL
Zip	:	33609-3139
Country	:	US
Telephone Number	:	813-879-8045
Fax Number	:	813-450-2461

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	06/07/2019

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