MEDICARE: DANIEL JOHN MCINTYRE 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	PA02561	TX

General Provider Information

NPI Number	:	1609887595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL JOHN MCINTYRE PA-C

Provider Business Mailing Address
First Line	:	6340 NORTH BEACH STREET
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137
Country	:	US
Telephone Number	:	817-514-8668
Fax Number	:

Provider Business Practice Location Address
First Line	:	6340 N BEACH ST
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76137-2622
Country	:	US
Telephone Number	:	817-514-8668
Fax Number	:

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	11/17/2008

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