Basic Information
Provider Information
NPI: 1154721066
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DROUKAS
FirstName: DANIEL
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 55310
Address2:  
City: BIRMINGHAM
State: AL
PostalCode: 352555310
CountryCode: US
TelephoneNumber: 2057319701
FaxNumber:  
Practice Location
Address1: 619 19TH ST S
Address2:  
City: BIRMINGHAM
State: AL
PostalCode: 352491850
CountryCode: US
TelephoneNumber: 2059344011
FaxNumber: 2052979411
Other Information
ProviderEnumerationDate: 08/27/2014
LastUpdateDate: 06/18/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X38263ALY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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