Individual
DR. THEMEN S. DANIELSON JR.
Active
Individual
DR. THEMEN S. DANIELSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01025278A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000383565
ANTHEM
—
01
—
01025278
IN STATE LIC NUMBER
IN
01
—
10781256
CAQH
—
Enumeration date
06/23/2006
Last updated
07/08/2007
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