Basic Information
| Provider Information | |||||||||
| NPI: | 1639197965 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DALY | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1106 DRUID RD S | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337563846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275846266 | ||||||||
| FaxNumber: | 7275811575 | ||||||||
| Practice Location | |||||||||
| Address1: | 1106 DRUID RD S | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337563846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275846266 | ||||||||
| FaxNumber: | 7275811575 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 11/11/2009 | ||||||||
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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 | 2084P0800X | ME28945 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 2581949-00 | 05 | FL | MEDICAID | 3734463-00 | 05 | FL | MEDICAID |