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General NPI Number Information
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NPI Number | 1376536805
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Entity Type | Individual
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Provider Name | DANIEL ERIC ROUSCH D.O.
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Gender | Male
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Dates
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Enumeration Date | 08/30/2005
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Last Update Date | 09/01/2023
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Provider Practice Location Address
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Address Line | 1236 SOUTHRIDGE CT STE 201
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City | HURST
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State | TX
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Zip | 76053-4284
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Country | US
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Telephone | 817-585-6807
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Fax | 817-394-2119
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Provider Business Mailing Address
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Address Line | 1236 SOUTHRIDGE CT STE 201
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City | HURST
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State | TX
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Zip | 76053-4284
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Country | US
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Telephone | 817-585-6807
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Fax | 817-394-2119
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | J4488
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License Number State | TX
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