MEDICARE: DANIEL ERIC ROUSCH 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	2084P0800X	Psychiatry Physician	J4488	TX

General Provider Information

NPI Number	:	1376536805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL ERIC ROUSCH D.O.

Provider Business Mailing Address
First Line	:	1236 SOUTHRIDGE CT STE 201
Second Line	:
City	:	HURST
State	:	TX
Zip	:	76053-4284
Country	:	US
Telephone Number	:	817-585-6807
Fax Number	:	817-394-2119

Provider Business Practice Location Address
First Line	:	1236 SOUTHRIDGE CT STE 201
Second Line	:
City	:	HURST
State	:	TX
Zip	:	76053-4284
Country	:	US
Telephone Number	:	817-585-6807
Fax Number	:	817-394-2119

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	09/01/2023

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