Provider Demographics
NPI:1194159129
Name:DALY, PATRICK JAMES JR (IDC)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:JAMES
Last Name:DALY
Suffix:JR
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 AREA BRANCH MEDICAL CLINIC
Mailing Address - Street 2:EDSON RANGE
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055
Mailing Address - Country:US
Mailing Address - Phone:760-725-7351
Mailing Address - Fax:
Practice Address - Street 1:31 AREA BRANCH MEDICAL CLINIC
Practice Address - Street 2:EDSON RANGE
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:760-725-7351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman