Provider Demographics
NPI:1497851786
Name:DANIEL, WILLIAM D (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:D
Last Name:DANIEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1615 MCMINNVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-3179
Mailing Address - Country:US
Mailing Address - Phone:931-728-6205
Mailing Address - Fax:931-723-3194
Practice Address - Street 1:1615 MCMINNVILLE HWY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-3179
Practice Address - Country:US
Practice Address - Phone:931-728-6205
Practice Address - Fax:931-723-3194
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO 738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G702278OtherGROUP TRANSACTION ACCESS NUMBER
TN4139428OtherTENNCARE
TN3302198Medicaid
TN4139428OtherBLUE CROSS
TNTN0105OtherAMERICHOICE
TN103I082276Medicare PIN
TN4139428OtherBLUE CROSS
D74238Medicare UPIN