Provider Demographics
NPI:1275783623
Name:DANIEL CONSTANCE, M.D. PLLC
Entity Type:Organization
Organization Name:DANIEL CONSTANCE, M.D. PLLC
Other - Org Name:SOUTHWEST OKLAHOMA SPORTS & INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CONSTANCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-536-1111
Mailing Address - Street 1:5606 SW LEE BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505
Mailing Address - Country:US
Mailing Address - Phone:580-536-1111
Mailing Address - Fax:580-536-2211
Practice Address - Street 1:5606 SW LEE BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505
Practice Address - Country:US
Practice Address - Phone:580-536-1111
Practice Address - Fax:580-536-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty