MEDICARE: DANIEL SIMON SCHLUSSELBERG 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	2085R0202X	Diagnostic Radiology Physician	G3766	TX

General Provider Information

NPI Number	:	1861698276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL SIMON SCHLUSSELBERG M.D.

Provider Business Mailing Address
First Line	:	12807 ISOCOMA ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-3612
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6090 SURETY DR STE 101
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79905-2060
Country	:	US
Telephone Number	:	915-772-1177
Fax Number	:

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

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	07/08/2007

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