Doctor Name: | DANIEL D DSTTEFFANO |
NPI Number: | 1740531011 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | ACN543 |
Business Practice Address: | 212 S Florida St Clark Clinic Inc Bushnell, FL - 335136703 |
Business Phone Number: | 3527932441 |
Business Fax Number: | |
Mailing Address: | 212 S Florida St, Clark Clinic Inc BUSHNELL |
State: | FL |
Postal Code: | 335136703 |
Phone Number: | 3527932441 |
Fax Number: | |
NPI Enumeration Date: | 09/27/2012 |
NPI Last Update Date: | 06/18/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ACN543 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |