Provider Demographics
NPI:1659600989
Name:WALTER H. DANIELS, M.D. A PROFESSIONAL MEDICAL CORP.
Entity Type:Organization
Organization Name:WALTER H. DANIELS, M.D. A PROFESSIONAL MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:H
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-385-2710
Mailing Address - Street 1:P.O. BOX 3615
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70381
Mailing Address - Country:US
Mailing Address - Phone:985-385-2710
Mailing Address - Fax:985-384-8217
Practice Address - Street 1:1300 LAKEWOOD DRIVE
Practice Address - Street 2:SUITE G
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380
Practice Address - Country:US
Practice Address - Phone:985-385-2710
Practice Address - Fax:985-384-8217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty