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General NPI Number Information
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NPI Number | 1578718011
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Entity Type | Organization
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Legal Business Name | MCDANIEL CLINIC, P. A.
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Dates
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Enumeration Date | 11/25/2008
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Last Update Date | 11/25/2008
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Provider Practice Location Address
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Address Line | 1608 WEST FM 700 STE A
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City | BIG SPRING
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State | TX
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Zip | 79720-4113
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Country | US
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Telephone | 432-267-1014
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Fax | 432-267-2604
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Provider Business Mailing Address
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Address Line | 1608 WEST FM 700 STE A
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City | BIG SPRING
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State | TX
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Zip | 79720-4113
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Country | US
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Telephone | 432-267-1014
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Fax | 432-267-2604
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Authorized Official
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Title or Position | DIRECTOR
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Name | CLARK R MCDANIEL
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Credential | M.D.
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Telephone | 432-267-1014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | E2289
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License Number State | TX
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