Provider Demographics
NPI:1982643581
Name:DANIEL, RICHARD HARTMAN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:HARTMAN
Last Name:DANIEL
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 1:3601 NORTH STAR RD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082
Mailing Address - Country:US
Mailing Address - Phone:972-231-9421
Mailing Address - Fax:972-907-8779
Practice Address - Street 1:3601 NORTH STAR RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082
Practice Address - Country:US
Practice Address - Phone:972-231-9421
Practice Address - Fax:972-907-8779
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5885208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112124602Medicaid
TX112124602Medicaid