Provider Demographics
NPI:1992010557
Name:RONALD L DANIELS DO PA
Entity Type:Organization
Organization Name:RONALD L DANIELS DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:903-763-2218
Mailing Address - Street 1:PO BOX 895
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75783-0895
Mailing Address - Country:US
Mailing Address - Phone:903-763-2218
Mailing Address - Fax:903-763-4308
Practice Address - Street 1:117 N WINNSBORO ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:TX
Practice Address - Zip Code:75783-2144
Practice Address - Country:US
Practice Address - Phone:903-763-2218
Practice Address - Fax:903-763-4308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-07
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3246261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115843802Medicaid
TX115843802Medicaid