MEDICARE: DR. DENNIS EDWARDS DANIELS MD

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	207RP1001X	Pulmonary Disease Physician	2003009194	MO
2	207RP1001X	Pulmonary Disease Physician	26336	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265404222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS EDWARDS DANIELS MD

Provider Business Mailing Address
First Line	:	1906A GREENWOOD DR
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-2430
Country	:	US
Telephone Number	:	573-778-5913
Fax Number	:	573-776-7750

Provider Business Practice Location Address
First Line	:	1906A GREENWOOD DR
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-2430
Country	:	US
Telephone Number	:	573-778-5913
Fax Number	:	573-776-7750

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	12/28/2017

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