MEDICARE: DAN EUGENE DURRIEU PA

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	261Q00000X	Clinic/Center	CH7730	FL

General Provider Information

NPI Number	:	1306055314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAN EUGENE DURRIEU PA

Provider Business Mailing Address
First Line	:	5015 W WATERS AVE
Second Line	:	SUITE D
City	:	TAMPA
State	:	FL
Zip	:	33634-1317
Country	:	US
Telephone Number	:	813-882-8181
Fax Number	:	813-882-3413

Provider Business Practice Location Address
First Line	:	5015 W WATERS AVE
Second Line	:	SUITE D
City	:	TAMPA
State	:	FL
Zip	:	33634-1317
Country	:	US
Telephone Number	:	813-882-8181
Fax Number	:	813-882-3413

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAN EUGENE DURRIEU
Credential	:	D.C.
Telephone Number	:	813-882-8181

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	01/27/2012

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