Provider Demographics
NPI:1255505590
Name:DANIEL, DANIEL A
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:A
Last Name:DANIEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 WESTMINISTER AVE
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4413
Mailing Address - Country:US
Mailing Address - Phone:972-384-1148
Mailing Address - Fax:972-278-5797
Practice Address - Street 1:405 MAYFIELD AVE
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-5420
Practice Address - Country:US
Practice Address - Phone:469-235-7047
Practice Address - Fax:972-278-5750
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0064156332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156209202Medicaid
TX156209201Medicaid
TX156209201Medicaid