Healthcare Provider Details

I. General information

NPI: 1609887595
Provider Name (Legal Business Name): DANIEL JOHN MCINTYRE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6340 N BEACH ST
HALTOM CITY TX
76137-2622
US

IV. Provider business mailing address

6340 NORTH BEACH STREET
FORT WORTH TX
76137
US

V. Phone/Fax

Practice location:
  • Phone: 817-514-8668
  • Fax:
Mailing address:
  • Phone: 817-514-8668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA02561
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: