Provider Demographics
NPI:1790529477
Name:BREYSSE, DANIEL HAYES VAN FOSSEN (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:HAYES VAN FOSSEN
Last Name:BREYSSE
Suffix:
Gender:M
Credentials:DO
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 16052
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-6052
Mailing Address - Country:US
Mailing Address - Phone:484-628-8333
Mailing Address - Fax:484-628-8334
Practice Address - Street 1:PO BOX 16052
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19612-6052
Practice Address - Country:US
Practice Address - Phone:484-628-8333
Practice Address - Fax:484-628-8334
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT023896207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology