Provider Demographics
NPI:1104289115
Name:MCDANIEL, BRIAN PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PATRICK
Last Name:MCDANIEL
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 1:400 PINELLAS ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3312
Mailing Address - Country:US
Mailing Address - Phone:727-462-3696
Mailing Address - Fax:813-635-2656
Practice Address - Street 1:400 PINELLAS ST STE 350
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3319
Practice Address - Country:US
Practice Address - Phone:727-462-3696
Practice Address - Fax:813-635-2656
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME133340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103849900Medicaid