Provider Demographics
NPI:1003086638
Name:DANIEL, ANASSERIL E (MD)
Entity Type:Individual
Prefix:DR
First Name:ANASSERIL
Middle Name:E
Last Name:DANIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 E BROADWAY STE 115
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4207
Mailing Address - Country:US
Mailing Address - Phone:573-443-6930
Mailing Address - Fax:573-875-4272
Practice Address - Street 1:33 E BROADWAY STE 115
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4207
Practice Address - Country:US
Practice Address - Phone:573-443-6930
Practice Address - Fax:573-875-4272
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR 60292084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry