Provider Demographics
NPI:1316352099
Name:POOR, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:POOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8675 WINE LEAF CV
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-4443
Mailing Address - Country:US
Mailing Address - Phone:646-645-9779
Mailing Address - Fax:
Practice Address - Street 1:BAPTIST MEMORIAL HOSPITAL MEMPHIS
Practice Address - Street 2:124 N. HUMPHREY'S BLVD
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120
Practice Address - Country:US
Practice Address - Phone:902-226-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-21
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-10782207P00000X
MS25383207P00000X
NJ#39390200000X
TN56527207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ12345Medicaid
NJ1316352099Medicaid