Provider Demographics
NPI:1922244912
Name:REBECCA J DANIELS, MD LLC
Entity Type:Organization
Organization Name:REBECCA J DANIELS, MD LLC
Other - Org Name:DANIELS COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-707-3000
Mailing Address - Street 1:406 E HALL OF FAME AVE
Mailing Address - Street 2:# 100
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-5428
Mailing Address - Country:US
Mailing Address - Phone:405-707-3000
Mailing Address - Fax:405-707-3015
Practice Address - Street 1:406 E HALL OF FAME AVE
Practice Address - Street 2:# 100
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-5428
Practice Address - Country:US
Practice Address - Phone:405-707-3000
Practice Address - Fax:405-707-3015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK247300702Medicare PIN