Basic Information
Provider Information
NPI: 1174503288
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DANIEL
FirstName: CLIFTON
MiddleName: R
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7111 FAIRWAY DR
Address2: SUITE 400
City: PALM BEACH GARDENS
State: FL
PostalCode: 334184204
CountryCode: US
TelephoneNumber: 5617126265
FaxNumber: 5617127349
Practice Location
Address1: 908 WRIGHT ST
Address2:  
City: ARLINGTON
State: TX
PostalCode: 760124730
CountryCode: US
TelephoneNumber: 8174604366
FaxNumber: 8174697563
Other Information
ProviderEnumerationDate: 01/17/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZP0102XD4970TXX Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
207ND0900XD4970TXX Allopathic & Osteopathic PhysiciansDermatologyDermatopathology

No ID Information.


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