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NPI Code Detail

MEDICARE: ROOSEVELT G DANIEL MD

MEDICARE: ROOSEVELT G DANIEL 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
1207R00000XInternal Medicine Physician27716SC
2208000000XPediatrics Physician27716SC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00906560OTHERSCRAILROAD MEDICARE PTAN

General Provider Information

NPI Number : 1275571846
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROOSEVELT G DANIEL MD
Provider Business Mailing Address
First Line : 2749 CARRIAGE LN
Second Line :
City : FLORENCE
State : SC
Zip : 29505-6498
Country : US
Telephone Number : 843-673-7046
Fax Number :
Provider Business Practice Location Address
First Line : 545 SUMTER HWY
Second Line :
City : BISHOPVILLE
State : SC
Zip : 29010-7601
Country : US
Telephone Number : 803-484-5317
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2006
Last Update Date : 10/10/2011

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Directions to “ ROOSEVELT G DANIEL MD” Practice Location

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