Healthcare Provider Details

I. General information

NPI: 1730125865
Provider Name (Legal Business Name): GENE MCDANIEL DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 02/26/2013
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 Number
License Number State

VIII. Authorized Official

Name: WENDELL GENE MCDANIEL
Title or Position: PRESIDENT
Credential: DO
Phone: 817-523-5402