Provider Demographics
NPI:1609015452
Name:DZIADOSZ, DANIEL R (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:DZIADOSZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 7TH ST S STE 100
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4719
Mailing Address - Country:US
Mailing Address - Phone:727-553-7431
Mailing Address - Fax:727-553-7432
Practice Address - Street 1:603 7TH ST S STE 100
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4719
Practice Address - Country:US
Practice Address - Phone:727-553-7431
Practice Address - Fax:727-553-7432
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302025207X00000X, 207XX0801X, 207XX0801X, 207X00000X
FLME103748207XX0801X
KY46778207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL328012OtherAVMED
GA003162720AMedicaid
FL018363000Medicaid
FL1186918OtherCIGNA
FL14515OtherBCBS
FL9262296OtherAETNA
FL14515OtherBCBS