MEDICARE: DANIEL M. KATZ D.O.

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	207Q00000X	Family Medicine Physician	OP00001704	WA

General Provider Information

NPI Number	:	1316087042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL M. KATZ D.O.

Provider Business Mailing Address
First Line	:	PO BOX 11667
Second Line	:	SUITE B1
City	:	OLYMPIA
State	:	WA
Zip	:	98508-1667
Country	:	US
Telephone Number	:	360-705-1015
Fax Number	:	360-705-1313

Provider Business Practice Location Address
First Line	:	405 BLACK HILLS LN SW
Second Line	:	SUITE B1
City	:	OLYMPIA
State	:	WA
Zip	:	98502-8661
Country	:	US
Telephone Number	:	360-705-1015
Fax Number	:	360-705-1313

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	02/15/2017

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