Provider Demographics
NPI:1558461137
Name:GYSBERS, DANIEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:G
Last Name:GYSBERS
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:PO BOX 7536
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7536
Mailing Address - Country:US
Mailing Address - Phone:573-445-7300
Mailing Address - Fax:573-445-7301
Practice Address - Street 1:404 N KEENE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201
Practice Address - Country:US
Practice Address - Phone:573-445-7300
Practice Address - Fax:573-445-7301
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103012207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203941034Medicaid