Individual
JUSTIN L DAIGRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1103 16TH AVE SE, DECATUR, AL 35601-3595
(256) 350-0362
(256) 355-9779
Mailing address
1103 16TH AVE SE, DECATUR, AL 35601-3595
(256) 350-0362
(256) 355-9779
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
24565
WV
207X00000X
Orthopaedic Surgery Physician
24565
WV
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
Primary
34176
AL
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
35.123634
OH
208600000X
Surgery Physician
R9794
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102I708313
MEDICARE PTAN
AL
05
—
172883
—
AL
Enumeration date
06/24/2008
Last updated
10/13/2015
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