MEDICARE: DANIEL DAVID COURSON MS, PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA 15531	CA

General Provider Information

NPI Number	:	1083716518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL DAVID COURSON MS, PA-C

Provider Business Mailing Address
First Line	:	1713 MARSON ST
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-2233
Country	:	US
Telephone Number	:	760-622-7593
Fax Number	:

Provider Business Practice Location Address
First Line	:	5575 RUFFIN RD STE 100
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1361
Country	:	US
Telephone Number	:	858-277-2744
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2006
Last Update Date	:	07/08/2007

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