Basic Information
| Provider Information | |||||||||
| NPI: | 1710926456 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERCU | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 CHURCH ST APT 2402 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372193614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159812945 | ||||||||
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| Practice Location | |||||||||
| Address1: | 80 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | BARBOURVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 409067363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6065464175 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 04/03/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 1660 | TN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 02366 | KY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000388887 | 01 | KY | BCBS | OTHER | 009938016 | 05 | AL | MEDICAID | 3319479 | 05 | TN | MEDICAID | 4102763 | 01 | TN | BCBS | OTHER | 64023666 | 05 | KY | MEDICAID | 009941836 | 05 | AL | MEDICAID | P00235725 | 01 | TN | RAILROAD MEDICARE | OTHER | P00358034 | 01 | KY | RAILROAD MEDICARE | OTHER |