Provider Demographics
NPI:1962468538
Name:MCDANIEL, BRIAN DEAN (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:DEAN
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 HOSPITAL DR
Mailing Address - Street 2:SUITE 400A
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5775
Mailing Address - Country:US
Mailing Address - Phone:361-574-1888
Mailing Address - Fax:361-574-1890
Practice Address - Street 1:2705 HOSPITAL DR
Practice Address - Street 2:SUITE 400A
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5775
Practice Address - Country:US
Practice Address - Phone:361-574-1888
Practice Address - Fax:361-574-1890
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0099208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88621SOtherBLUE CROSS/SHIELD
TX8BV701OtherBLUECROSS BLUESHIELD OF TEXAS
UT135927502Medicaid
TXF11122Medicare UPIN
TX88621SOtherBLUE CROSS/SHIELD