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1780692079

NPI Code Detail

MEDICARE: ANDREW P DAIGLE MD

MEDICARE: ANDREW P DAIGLE MD

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	207P00000X	Emergency Medicine Physician	ME61517	FL
2	207Q00000X	Family Medicine Physician	13573	SC
3	207Q00000X	Family Medicine Physician	27686	AL
4	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	0101246311	VA
5	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	61517	FL
6	207P00000X	Emergency Medicine Physician	56034	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	203013	OTHER	SC	MEDCOST
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	7227499	OTHER	SC	AETNA
4	C06778	OTHER	VA	GROUP PTAN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780692079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW P DAIGLE MD

Provider Business Mailing Address
First Line	:	4266 SUNBEAM RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-2425
Country	:	US
Telephone Number	:	904-407-7700
Fax Number	:	904-407-6001

Provider Business Practice Location Address
First Line	:	4266 SUNBEAM RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-2425
Country	:	US
Telephone Number	:	904-407-7700
Fax Number	:	904-407-6001

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	02/15/2021

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Directions to “ ANDREW P DAIGLE MD” Practice Location

Language	Start Address	Practice Location

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