Provider Demographics
NPI:1154331726
Name:DANIEL, BOBBY N (DO)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:N
Last Name:DANIEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:BOBBY
Other - Middle Name:N
Other - Last Name:DANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4833 S SHERIDAN RD
Mailing Address - Street 2:SUITE414
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-5750
Mailing Address - Country:US
Mailing Address - Phone:918-488-9992
Mailing Address - Fax:918-488-9993
Practice Address - Street 1:4833 S SHERIDAN RD
Practice Address - Street 2:SUITE 414
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-5750
Practice Address - Country:US
Practice Address - Phone:918-488-9992
Practice Address - Fax:918-488-9993
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1843208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK374513Medicare ID - Type Unspecified
OK374507Medicare ID - Type Unspecified
OKD38567Medicare UPIN
OK374512Medicare ID - Type Unspecified