Doctor Name: | DR. CLARK RICHARD MCDANIEL |
NPI Number: | 1083726970 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | E2289 |
Business Practice Address: | 1608 W Fm 700 Ste A Big Spring, TX - 797204113 |
Business Phone Number: | 4322130794 |
Business Fax Number: | 4322672604 |
Mailing Address: | 1608 W Fm 700, Ste A BIG SPRING |
State: | TX |
Postal Code: | 797204113 |
Phone Number: | 6157788544 |
Fax Number: | 6156286877 |
NPI Enumeration Date: | 08/31/2006 |
NPI Last Update Date: | 04/18/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | E2289 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |