Provider Demographics
NPI:1407198286
Name:MCDANIEL, GARY STEPHEN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:STEPHEN
Last Name:MCDANIEL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:8080 BLUEBONNET BLVD STE 1000
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-7827
Mailing Address - Country:US
Mailing Address - Phone:225-442-3166
Mailing Address - Fax:225-400-6495
Practice Address - Street 1:8585 PICARDY AVE STE 518
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3748
Practice Address - Country:US
Practice Address - Phone:225-442-3166
Practice Address - Fax:225-400-6495
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.207498207L00000X, 207LP2900X, 208VP0014X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine