MEDICARE: DANIEL BURGESS LANKFORD 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	390200000X	Student in an Organized Health Care Education/Training Program
2	2085R0202X	Diagnostic Radiology Physician	N2617	TX

General Provider Information

NPI Number	:	1881850436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL BURGESS LANKFORD M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3926
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76902-3926
Country	:	US
Telephone Number	:	325-658-3576
Fax Number	:	325-658-7737

Provider Business Practice Location Address
First Line	:	3308 FOSTER ST
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76903-9314
Country	:	US
Telephone Number	:	325-658-3576
Fax Number	:	325-658-7737

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

Provider Enumeration Date	:	08/04/2008
Last Update Date	:	06/04/2013

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