Provider Demographics
NPI:1083688006
Name:DANIEL, LYNNELL MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNNELL
Middle Name:MARIE
Last Name:DANIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LYNNELL
Other - Middle Name:MARIE
Other - Last Name:SORRELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3519 BLACKSTONE RUN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2619
Mailing Address - Country:US
Mailing Address - Phone:210-481-9120
Mailing Address - Fax:
Practice Address - Street 1:2200 BERGQUIST DR
Practice Address - Street 2:LACKLAND AIR FORCE BASE
Practice Address - City:LACKLAND A F B
Practice Address - State:TX
Practice Address - Zip Code:78236-9907
Practice Address - Country:US
Practice Address - Phone:210-292-7956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056042A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology