Individual
LEROY VICTOR DANIELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11 HOSPITAL DR, MACHIAS, ME 04654
(207) 255-3356
Mailing address
14 MAINE ST # 44, BRUNSWICK, ME 04011-2049
(207) 725-9065
(207) 560-9904
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MD2014-0219
NM
207P00000X
Emergency Medicine Physician
Primary
MD21872
ME
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/20/2011
Last updated
07/01/2019
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