MEDICARE: GUS DANIELS, M.D. P.A.

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1548497555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUS DANIELS, M.D. P.A.

Provider Business Mailing Address
First Line	:	3711 MEDICAL DR APT 635
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-2284
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3711 MEDICAL DR APT 635
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-2284
Country	:	US
Telephone Number	:	210-616-0245
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GUS DANIELS
Credential	:	M.D.
Telephone Number	:	210-232-2649

Provider Enumeration Date	:	06/17/2009
Last Update Date	:	06/17/2009

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