JUSTIN L DAIGRE (NPI# 1215198007) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215198007 |
| Entity Type | Individual |
| Full Name | JUSTIN L DAIGRE |
| Credential | MD |
| Practice Address |
1103 16th Ave Se Decatur AL 35601-3595 |
| Practice Telephone | 2563500362 |
| Practice Fax Number | 2563559779 |
| Mailing Telephone | 2563500362 |
| Mailing Fax Number | 2563559779 |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2015-10-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 174400000X | Specialist | 24565 | WV | Other Service Providers |
| N | 207X00000X | Orthopaedic Surgery | 24565 | WV | Allopathic & Osteopathic Physicians |
| Y | 207XX0004X |
Orthopaedic Surgery Specialization: Foot and Ankle Surgery |
34176 | AL | Allopathic & Osteopathic Physicians |
| N | 207XX0004X |
Orthopaedic Surgery Specialization: Foot and Ankle Surgery |
35.123634 | OH | Allopathic & Osteopathic Physicians |
| N | 208600000X | Surgery | R9794 | AL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | MEDICARE PTAN | 102I708313 | 01 |
| AL | 172883 | 05 |
| Street Address |
1103 16TH AVE SE |
| City | DECATUR |
| State | AL |
| Zip Code | 35601-3595 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104904903 | Phillip Shannon Farris | Physician Assistant | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2006-11-01 |
| 1962036665 | Krista Butts | Nurse Practitioner | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2020-03-03 |
| 1295240588 | Eric Todd Smith | Technician/Technologist | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2017-12-07 |
| 1679095699 | Jeremy Keith Urban | Nurse Practitioner | 1103 16th Ave Se, Decatur, AL 35601 | 2017-07-11 |
| 1699169474 | Nicholas Krishnan | Physician Assistant | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2015-03-19 |
| 1841633187 | Justin David Hallock | Orthopaedic Surgery | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2013-04-16 |
| 1073854626 | Meghan Pace Hollimon | Nurse Practitioner | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2013-03-06 |
| 1902045867 | Janice D Draper | Physical Therapist | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2009-02-16 |
| 1023234648 | Charles Edward Fortenberry | Nurse Practitioner | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2007-04-18 |
| 1740331347 | Decatur Orthopaedic Clinic, LLC | Physical Medicine & Rehabilitation | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2007-01-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376000679 | Monica Dawn Ross | Counselor | 106 Lee St. Ne, Suite C, Decatur, AL 35601 | 2019-02-23 |
| 1063950319 | Samantha Elizabeth Pickett | Nurse Practitioner | 1115 Beltline Rd Se, Ste 400, Decatur, AL 35601 | 2017-02-07 |
| 1497208250 | Beronica Goodwin | Home Health Aide | 1102b Suite #2 4th Ave Se, Decatur, AL 35601 | 2016-07-28 |
| 1770957177 | Xochitl Dupre | Obstetrics & Gynecology | 1874 Beltline Road Sw, Suite 105, Decatur, AL 35601 | 2015-11-23 |
| 1104224708 | River City Psychiatry, Inc. | Community/Behavioral Health | 115 Johnston Street, Se, Suite 202, Decatur, AL 35601 | 2014-12-12 |
| 1760882690 | Derrick Aaron Randolph | Registered Nurse | 1207 7th St S.e., Decatur/morgan Hospital - Parkway Campus, Decatur, GA 35601 | 2014-08-28 |
| 1427465434 | Martha Read | Family Medicine | 2208 Danville Rd Sw Ste A, Decatur, AL 35601 | 2014-07-22 |
| 1205242948 | Pure Heart Home Care of Alabama, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 107 B 14th Street Sw, Decatur, AL 35601 | 2014-07-02 |
| 1720492242 | Christopher John Phillips | Emergency Medicine | 1201 7th Street Se, Decatur, AL 35601 | 2014-06-12 |
| 1366794711 | Complete Dental Decatur LLC | Dentist | 1241 Point Mallard Parkway, Suite. 105, Decatur, AL 35601 | 2012-10-10 |
| Find all providers in zip 35601 | ||||
| Taxonomy Code | 207XX0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Foot and Ankle Surgery |
| Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, foot and ankle surgeons deal with adult reconstructive foot and ankle surgery, adult foot and ankle trauma, sports medicine foot and ankle, and children's foot and ankle reconstructive surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: title modified, definiton added, source added] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Separate board certification is not currently offered. ACGME Accredited Residency Program Requirements: 1 year of training with 5 years Orthopedic Surgery for a total of 6 years. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194387571 | Nathaniel A Ptak | Orthopaedic Surgery | 1670 Clairmont Rd, Decatur, GA 30033-4004 | 2019-07-05 |
| 1487140950 | Kanesha Monique Gillyard | Orthopaedic Surgery | 1670 Clairmont Rd, Decatur, GA 30033-4004 | 2018-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417022237 | Alabama Orthopaedic Clinic, PC | Orthopaedic Surgery | 7101 Us Highway 98 Ste 203, Daphne, AL 36526-9512 | 2006-11-21 |
| 1629021654 | Roswell Charles Morley | Orthopaedic Surgery | 4715 Whitesburg Dr S, Huntsville, AL 35802-1632 | 2006-05-19 |
| 1215407226 | Affinity Orthopedic Specialists LLC | Orthopaedic Surgery | 5018 Cahaba River Rd, Vestavia, AL 35243-2317 | 2018-12-03 |
| 1528357233 | Jefferson Bradley Sabatini | Orthopaedic Surgery | 927 Franklin St Se, Huntsville, AL 35801-4306 | 2011-04-04 |
| 1972832467 | Ashish Shah | Orthopaedic Surgery | 1201 11th Ave S, Suite 200, Birmingham, AL 35205-3410 | 2009-12-14 |
| 1083871131 | Grantham Mcaleer Shell | Orthopaedic Surgery | 3610 Springhill Memorial Dr N, Mobile, AL 36608-1162 | 2008-05-16 |
| 1184755621 | Norman E. Waldrop IIi | Orthopaedic Surgery | 805 Saint Vincents Dr, Suite 100, Birmingham, AL 35205-1636 | 2007-03-08 |
| 1376699561 | Francisco Jose Caycedo | Orthopaedic Surgery | 833 Saint Vincents Dr, Ste. 403, Birmingham, AL 35205-1606 | 2007-01-28 |
| 1780642710 | William Isaiah Park Iv | Orthopaedic Surgery | 6144 Airport Blvd, Mobile, AL 36608-3143 | 2006-05-01 |
| 1437114402 | Mark Donald Perry | Orthopaedic Surgery | 1601 Center St, Ste 3n, Mobile, AL 36604-1512 | 2006-04-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.