Provider Demographics
NPI:1750300406
Name:MCDANIEL, ALAN BOYER (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:BOYER
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7510 NORTHFOREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420
Mailing Address - Country:US
Mailing Address - Phone:843-572-1600
Mailing Address - Fax:843-572-1795
Practice Address - Street 1:7510 NORTHFOREST DRIVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420
Practice Address - Country:US
Practice Address - Phone:843-572-1600
Practice Address - Fax:843-572-1795
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035992174400000X
SCMMD.34454TL207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100116300AMedicaid
IN000000174151OtherANTHEM
INC24741Medicare UPIN
IN000000174151OtherANTHEM