Provider Demographics
NPI:1063612927
Name:AMOAH, DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:AMOAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20185
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34204-0185
Mailing Address - Country:US
Mailing Address - Phone:941-238-9900
Mailing Address - Fax:941-238-9770
Practice Address - Street 1:1220 59TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-4154
Practice Address - Country:US
Practice Address - Phone:941-238-9900
Practice Address - Fax:941-238-9770
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98876207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06332OtherBCBS
FLP00440473OtherRAILROAD MEDICARE
FL279495100Medicaid
FLP00440473OtherRAILROAD MEDICARE
AE160WMedicare PIN