MEDICARE: DR. JERRY 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	207L00000X	Anesthesiology Physician	9167	FL
2	207L00000X	Anesthesiology Physician	ME103913	FL
3	207L00000X	Anesthesiology Physician	N3000	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00826720	OTHER	TX	RAILROAD MEDICARE

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
2	8CD178	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1326296310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY DANIEL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 251606
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-1510
Country	:	US
Telephone Number	:	972-588-4541
Fax Number	:	469-304-0139

Provider Business Practice Location Address
First Line	:	400 CHISHOLM PL STE 406
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-6911
Country	:	US
Telephone Number	:	972-588-4541
Fax Number	:	469-304-0139

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

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	09/20/2022

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Directions to “ DR. JERRY DANIEL M.D.” Practice Location

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