Healthcare Provider Details

I. General information

NPI: 1942464771
Provider Name (Legal Business Name): DANIEL EDWARD HOUSEMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 04/25/2020
Certification Date: 04/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 LINDEN AVE LONG BEACH EMERGENCY MEDICAL GROUP
LONG BEACH CA
90813-3321
US

IV. Provider business mailing address

1050 LINDEN AVE LONG BEACH EMERGENCY MEDICAL GROUP
LONG BEACH CA
90813-3321
US

V. Phone/Fax

Practice location:
  • Phone: 562-491-9762
  • Fax: 562-491-9264
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberM-15012
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD197782
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA110195
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: