Provider Demographics
NPI:1730125865
Name:GENE MCDANIEL DO PA
Entity Type:Organization
Organization Name:GENE MCDANIEL DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-523-5402
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80192642OtherRR MEDICARE
TX0093JAOtherBCBS
TX154733301Medicaid
TX4959470001OtherDME
TX0093JAOtherBCBS