Basic Information
| Provider Information | |||||||||
| NPI: | 1184617839 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCDYER | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3627 UNIVERSITY BLVD S | ||||||||
| Address2: | STE 340 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322164294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043963518 | ||||||||
| FaxNumber: | 9043985066 | ||||||||
| Practice Location | |||||||||
| Address1: | 3627 UNIVERSITY BLVD S | ||||||||
| Address2: | STE 340 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322164294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043963518 | ||||||||
| FaxNumber: | 9043985066 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2005 | ||||||||
| LastUpdateDate: | 03/31/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | ME0061345 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 375661100 | 05 | FL | MEDICAID |