MEDICARE: DR. JOEL BRUCE DACUS D.P.M.

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	213EP1101X	Primary Podiatric Medicine Podiatrist	2003	TX

General Provider Information

NPI Number	:	1699034728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL BRUCE DACUS D.P.M.

Provider Business Mailing Address
First Line	:	PO BOX 834
Second Line	:
City	:	SANGER
State	:	TX
Zip	:	76266-0834
Country	:	US
Telephone Number	:	214-404-9376
Fax Number	:

Provider Business Practice Location Address
First Line	:	4444 HERITAGE TRACE PKWY STE 400
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-8944
Country	:	US
Telephone Number	:	817-424-3668
Fax Number	:	817-741-4001

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

Provider Enumeration Date	:	05/09/2012
Last Update Date	:	08/30/2019

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