MEDICARE: DANIEL COULTER 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
1	2084F0202X	Forensic Psychiatry Physician	139926	CA
2	2084P0800X	Psychiatry Physician	T3452	TX

General Provider Information

NPI Number	:	1487850905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL COULTER MD

Provider Business Mailing Address
First Line	:	1600 9TH ST STE 150
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-6476
Country	:	US
Telephone Number	:	916-654-6797
Fax Number	:	916-651-8908

Provider Business Practice Location Address
First Line	:	308 S FRIENDSWOOD DR STE 200
Second Line	:
City	:	FRIENDSWOOD
State	:	TX
Zip	:	77546-3989
Country	:	US
Telephone Number	:	844-824-8775
Fax Number	:

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

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	10/13/2023

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