Provider Demographics
NPI:1841596574
Name:DONOVAN, DANIEL SHAWN
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:SHAWN
Last Name:DONOVAN
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:PO BOX 447
Mailing Address - Street 2:803 N.W. 7TH ST
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-0447
Mailing Address - Country:US
Mailing Address - Phone:918-967-8558
Mailing Address - Fax:
Practice Address - Street 1:803 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-2794
Practice Address - Country:US
Practice Address - Phone:918-967-8558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator