MEDICARE: DR. DANIEL IRWIN DIAL 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	174400000X	Specialist	LA11123R	LA

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	:	1386618908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL IRWIN DIAL M.D.

Provider Business Mailing Address
First Line	:	10880 JOOR ROAD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70818
Country	:	US
Telephone Number	:	225-262-7710
Fax Number	:	225-262-7714

Provider Business Practice Location Address
First Line	:	2524 LAUREL LAKES AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70820-5736
Country	:	US
Telephone Number	:	225-769-4171
Fax Number	:	225-262-7714

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	02/15/2013

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