Individual
ROOSEVELT G DANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
545 SUMTER HWY, BISHOPVILLE, SC 29010-7601
(803) 484-5317
Mailing address
2749 CARRIAGE LN, FLORENCE, SC 29505-6498
(843) 673-7046
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
27716
SC
208000000X
Pediatrics Physician
27716
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00906560
RAILROAD MEDICARE PTAN
SC
Enumeration date
06/03/2006
Last updated
10/10/2011
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