# DANIELS FAMILY MEDICAL CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053594507
- **Authorized official:** LARRY CLYDE DANIELS M.D. (OWNER, SOLE MEMBER)
- **Authorized official phone:** (318) 934-0082

## Contact information

- **Practice address:** 3736 N MARKET ST, SUITE 100, SHREVEPORT, LA 71107-3104
- **Practice address phone:** (318) 934-0082
- **Mailing address:** PO BOX 7276, SHREVEPORT, LA 71137-7276
- **Mailing address phone:** (318) 934-0082

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 06282R | LA | Yes |

## Other

- **Enumeration date:** 12/06/2007
- **Last updated:** 12/12/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1352896 | — | LA |