Individual
ROOSEVELT G DANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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