Provider Demographics
NPI:1023178332
Name:FIELDS, DANIEL D (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:D
Last Name:FIELDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 WEST 7TH STREET
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BRISTOW
Mailing Address - State:OK
Mailing Address - Zip Code:74010
Mailing Address - Country:US
Mailing Address - Phone:918-367-4443
Mailing Address - Fax:913-367-9190
Practice Address - Street 1:700 WEST 7TH STREET
Practice Address - Street 2:SUITE 6
Practice Address - City:BRISTOW
Practice Address - State:OK
Practice Address - Zip Code:74010
Practice Address - Country:US
Practice Address - Phone:918-367-4443
Practice Address - Fax:918-367-9190
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK18055207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100217590DMedicaid
F75488Medicare UPIN
400522419Medicare ID - Type Unspecified