MEDICARE: DR. FREDERICK WILLIAM DANIELS 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	2080A0000X	Pediatric Adolescent Medicine Physician	14524	SC

General Provider Information

NPI Number	:	1609832351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK WILLIAM DANIELS MD

Provider Business Mailing Address
First Line	:	4326 BALDWIN AVE
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-8207
Country	:	US
Telephone Number	:	843-249-7400
Fax Number	:	843-249-7440

Provider Business Practice Location Address
First Line	:	8120 ROURK ST
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-4127
Country	:	US
Telephone Number	:	843-449-1438
Fax Number	:	843-449-9018

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

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	07/08/2007

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