Healthcare Provider Details

I. General information

NPI: 1346295698
Provider Name (Legal Business Name): DANIEL L STICKLER II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3353 TUSCANY DR
DRIFTWOOD TX
78619-2056
US

IV. Provider business mailing address

3353 TUSCANY DR
DRIFTWOOD TX
78619-2056
US

V. Phone/Fax

Practice location:
  • Phone: 512-560-3694
  • Fax: 828-330-4985
Mailing address:
  • Phone: 512-560-3694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME144084
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2011-01840
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberS4397
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: