MEDICARE: DR. GREGORY STEPHEN DANIEL M.D.

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	207R00000X	Internal Medicine Physician	ME 49371	FL

General Provider Information

NPI Number	:	1134192214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY STEPHEN DANIEL M.D.

Provider Business Mailing Address
First Line	:	3240 S FLORIDA AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-4574
Country	:	US
Telephone Number	:	863-701-2470
Fax Number	:	863-701-2474

Provider Business Practice Location Address
First Line	:	3240 S FLORIDA AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-4574
Country	:	US
Telephone Number	:	863-701-2470
Fax Number	:	863-701-2474

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

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	11/29/2007

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