Healthcare Provider Details

I. General information

NPI: 1508802646
Provider Name (Legal Business Name): WENDELL GENE MCDANIEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 W HWY 199
SPRINGTOWN TX
76082
US

IV. Provider business mailing address

PO BOX 1039
SPRINGTOWN TX
76082
US

V. Phone/Fax

Practice location:
  • Phone: 817-523-5402
  • Fax: 817-523-5422
Mailing address:
  • Phone: 817-523-5402
  • Fax: 817-523-5422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL2457
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: