Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | L8662 | TX |
NPI | 1003998865 |
---|---|
Provider Name | Clive G Daniels |
First Address | Dallas, TX 75373-3784 |
Second Address | Mansfield, TX 76063-9164 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 14/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G63542 | (02) |