Healthcare Provider Details

I. General information

NPI: 1982794160
Provider Name (Legal Business Name): JAMES DONALD MCDANIEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E APACHE PARK PL
TUCSON AZ
85714-1775
US

IV. Provider business mailing address

502 W 29TH ST
TUCSON AZ
85713-3353
US

V. Phone/Fax

Practice location:
  • Phone: 520-746-0260
  • Fax: 520-295-0834
Mailing address:
  • Phone: 520-884-9920
  • Fax: 520-792-0654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number18751
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: