MEDICARE: MR. BRUCE ALAN DANIELS MD

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
1	207RC0000X	Cardiovascular Disease Physician	10948	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972584050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRUCE ALAN DANIELS MD

Provider Business Mailing Address
First Line	:	4221 S WESTERN AVE
Second Line	:	STE 4045
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3447
Country	:	US
Telephone Number	:	405-636-1166
Fax Number	:	405-632-8446

Provider Business Practice Location Address
First Line	:	4221 S WESTERN AVE
Second Line	:	STE 4045
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3447
Country	:	US
Telephone Number	:	405-636-1166
Fax Number	:	405-632-8446

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	09/22/2020

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