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Organization
DANIELS FAMILY MEDICAL CENTER LLC
Active
Organization
DANIELS FAMILY MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY CLYDE DANIELS M.D. (OWNER, SOLE MEMBER)
(318) 934-0082
Entity
Organization
Contact information
Practice address
3736 N MARKET ST, SUITE 100, SHREVEPORT, LA 71107-3104
(318) 934-0082
Mailing address
PO BOX 7276, SHREVEPORT, LA 71137-7276
(318) 934-0082
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
06282R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1352896
—
LA
Enumeration date
12/06/2007
Last updated
12/12/2007
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