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General NPI Number Information
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NPI Number | 1275571846
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Entity Type | Individual
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Provider Name | ROOSEVELT G DANIEL MD
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Gender | Male
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 545 SUMTER HWY
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City | BISHOPVILLE
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State | SC
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Zip | 29010-7601
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Country | US
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Telephone | 803-484-5317
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Fax |
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Provider Business Mailing Address
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Address Line | 2749 CARRIAGE LN
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City | FLORENCE
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State | SC
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Zip | 29505-6498
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Country | US
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Telephone | 843-673-7046
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 27716
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 27716
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License Number State | SC
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