Individual
DANIEL ALLEN KOONTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
323 LEBBY ST, PELZER, SC 29669-1754
(864) 947-6666
(864) 947-8621
Mailing address
323 LEBBY ST, PELZER, SC 29669-1754
(864) 947-6666
(864) 947-8621
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11429
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003111796A
—
GA
01
—
060035928
MEDICARE RAILROAD
SC
05
—
114290
—
SC
01
—
570804286
FEDERAL TAX ID
SC
01
—
P01072951
RR MEDICARE
SC
Enumeration date
06/28/2006
Last updated
09/27/2012
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