Provider Demographics
NPI:1417931841
Name:DANIEL, WARREN ATTWOOD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:ATTWOOD
Last Name:DANIEL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:130 DESIARD ST
Mailing Address - Street 2:SUITE 355
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7319
Mailing Address - Country:US
Mailing Address - Phone:318-807-7875
Mailing Address - Fax:318-812-6603
Practice Address - Street 1:109 REGENCY PL
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-4453
Practice Address - Country:US
Practice Address - Phone:318-812-9999
Practice Address - Fax:318-323-9339
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2015-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA010670207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1120570Medicaid
LA1120570Medicaid
LA51736Medicare ID - Type Unspecified