Individual
DANIEL S TISMAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
820 PRUDENTIAL DR STE 304, JACKSONVILLE, FL 32207-8205
(904) 202-3860
(904) 202-3846
Mailing address
PO BOX 45443, SALT LAKE CITY, UT 84145-0443
(904) 202-1032
(904) 376-4104
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301097214
MI
207R00000X
Internal Medicine Physician
ME149085
FL
208M00000X
Hospitalist Physician
Primary
ME149085
FL
Other
Enumeration date
08/05/2010
Last updated
01/06/2022
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