Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | R4432 | TX |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | R4432 | TX |
NPI | 1306189808 |
---|---|
Provider Name | Alma Danielle Mcdaniel |
First Address | Irving, TX 75038-3813 |
Second Address | Corpus Christi, TX 78405-1804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2013 |
Last Update Date | 09/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1L5017 | MEDICARE (01) | TX |
378685701 | (05) | TX |
378685702 | (05) | TX |
P02601815 | MCRR (01) | TX |