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General NPI Number Information
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NPI Number | 1912110578
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Entity Type | Individual
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Provider Name | DANIEL GLENN CONSTANCE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 08/26/2011
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Provider Practice Location Address
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Address Line | 5606 SW LEE BOULEVARD SUITE 203
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City | LAWTON
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State | OK
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Zip | 73505
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Country | US
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Telephone | 580-536-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 5606 SW LEE BLVD SUITE 203
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City | LAWTON
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State | OK
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Zip | 73505-0000
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Country | US
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Telephone | 580-536-1111
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Fax | 580-536-2211
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301082389
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 26711
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 4301082389
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 26711
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License Number State | OK
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Taxonomy #5
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number | 4301082389
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License Number State | MI
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Taxonomy #6
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number | 26711
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License Number State | OK
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