Basic Information
| Provider Information | |||||||||
| NPI: | 1740282623 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VINCENT | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD, FACS | ||||||||
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| Mailing Information | |||||||||
| Address1: | SELECT PHYSICIANS ALLIANCE | ||||||||
| Address2: | 10002 PRINCESS PALM AVE. STE 332 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336198327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8135717184 | ||||||||
| FaxNumber: | 8136544695 | ||||||||
| Practice Location | |||||||||
| Address1: | FLORIDA ENT & ALLERGY | ||||||||
| Address2: | 3006 AZEELE ST | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336093139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138798045 | ||||||||
| FaxNumber: | 8134502461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 06/07/2019 | ||||||||
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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 | 207Y00000X | ME 75546 | FL | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | ME75546 | FL | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 255104700 | 05 | FL | MEDICAID | 295104700 | 05 | FL | MEDICAID |