Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | PA05470 | TX |
NPI | 1013104710 |
---|---|
Provider Name | Lacey A Mcdaniel |
First Address | Fort Worth, TX 76133-5912 |
Second Address | Fort Worth, TX 76133-5912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2007 |
Last Update Date | 28/02/2011 |