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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