MEDICARE: DANIEL BRYCE

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	363A00000X	Physician Assistant	5809	OK

General Provider Information

NPI Number	:	1457034928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL BRYCE

Provider Business Mailing Address
First Line	:	350 S 40TH ST
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-4915
Country	:	US
Telephone Number	:	918-684-2663
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 S 40TH ST
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-4915
Country	:	US
Telephone Number	:	918-684-2663
Fax Number	:

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

Provider Enumeration Date	:	08/10/2023
Last Update Date	:	01/12/2026

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