Provider Demographics
NPI:1295183325
Name:RICHARD, DANIEL LEE JR
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:LEE
Last Name:RICHARD
Suffix:JR
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 1:1525 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-6471
Mailing Address - Country:US
Mailing Address - Phone:337-304-5305
Mailing Address - Fax:337-376-5244
Practice Address - Street 1:610 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-2671
Practice Address - Country:US
Practice Address - Phone:337-304-5305
Practice Address - Fax:337-376-5244
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6431933343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA473357230OtherFEDERAL