MEDICARE: DR. DANIEL FREDERICK CASEY 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	207Q00000X	Family Medicine Physician	K2148	TX

General Provider Information

NPI Number	:	1457340010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL FREDERICK CASEY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 911294
Second Line	:	DALLAS
City	:	DALLAS
State	:	TX
Zip	:	75391-1294
Country	:	US
Telephone Number	:	817-852-8440
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 S MAIN ST
Second Line	:	FORT WORTH
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4917
Country	:	US
Telephone Number	:	817-927-1395
Fax Number	:

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	07/08/2007

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