Provider Demographics
NPI:1528158458
Name:SONTHEIMER, DANIEL L (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:SONTHEIMER
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 BAPTIST WAY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2254
Mailing Address - Country:US
Mailing Address - Phone:850-469-7406
Mailing Address - Fax:
Practice Address - Street 1:123 BAPTIST WAY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2254
Practice Address - Country:US
Practice Address - Phone:448-227-8478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003018088207Q00000X
FLME118202208M00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010399500Medicaid
210050038Medicare PIN
P00078233Medicare PIN
F95011Medicare UPIN