Provider Demographics
NPI:1104899889
Name:DRISCOLL, DANNI LUTES (MD)
Entity type:Individual
Prefix:
First Name:DANNI
Middle Name:LUTES
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DANNI
Other - Middle Name:LUTES
Other - Last Name:DRISCOLL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4600 LINTON BLVD
Mailing Address - Street 2:STE #250
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6600
Mailing Address - Country:US
Mailing Address - Phone:561-495-0087
Mailing Address - Fax:561-495-0026
Practice Address - Street 1:4600 LINTON BLVD
Practice Address - Street 2:STE #250
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6600
Practice Address - Country:US
Practice Address - Phone:561-495-0087
Practice Address - Fax:561-495-0026
Is Sole Proprietor?:No
Enumeration Date:2006-02-11
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85254207LP2900X, 207LA0401X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265770800Medicaid
FL265770800Medicaid
FL51537QMedicare ID - Type Unspecified
FL51537RMedicare ID - Type Unspecified