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NPI Code Detail

MEDICARE: LACEY A MCDANIEL PA-C

MEDICARE: LACEY A MCDANIEL PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine PhysicianPA05470TX
2363A00000XPhysician AssistantPA05470TX

General Provider Information

NPI Number : 1013104710
Entity Type Code : Individual
Provider Name (Legal Business Name) : LACEY A MCDANIEL PA-C
Provider Business Mailing Address
First Line : 7001 GRANBURY RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76133-5912
Country : US
Telephone Number : 817-346-1925
Fax Number : 817-292-7237
Provider Business Practice Location Address
First Line : 7001 GRANBURY RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76133-5912
Country : US
Telephone Number : 817-346-1925
Fax Number : 817-292-7237
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2007
Last Update Date : 02/28/2011

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Directions to “ LACEY A MCDANIEL PA-C” Practice Location

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