Provider Demographics
NPI:1508802646
Name:MCDANIEL, WENDELL GENE (DO)
Entity Type:Individual
Prefix:
First Name:WENDELL
Middle Name:GENE
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1039
Mailing Address - Street 2:
Mailing Address - City:SPRINGTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:76082
Mailing Address - Country:US
Mailing Address - Phone:817-523-5402
Mailing Address - Fax:817-523-5422
Practice Address - Street 1:308 W HWY 199
Practice Address - Street 2:
Practice Address - City:SPRINGTOWN
Practice Address - State:TX
Practice Address - Zip Code:76082
Practice Address - Country:US
Practice Address - Phone:817-523-5402
Practice Address - Fax:817-523-5422
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2457207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152810103Medicaid
TX0093JAOtherBCBS
TX8C8835OtherBCBS PROVIDER NO
TX8S6600OtherBCBSTX
TX152810103Medicaid