Provider Demographics
NPI:1790926103
Name:MCDANIEL, JEFFREY ALLEN
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALLEN
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 GLENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3463
Mailing Address - Country:US
Mailing Address - Phone:707-445-9291
Mailing Address - Fax:707-445-9292
Practice Address - Street 1:3300 GLENWOOD ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3463
Practice Address - Country:US
Practice Address - Phone:707-445-9291
Practice Address - Fax:707-445-9292
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator