Individual
WILBERT ELLIS MCDANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4522 SUMMERHILL RD, TEXARKANA, TX 75503-2740
(903) 838-3093
Mailing address
5750 JOHNSTON ST STE 502, LAFAYETTE, LA 70503-5334
(373) 417-9200
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
933915501
DRIVERS LICENSE
AR
Enumeration date
11/18/2021
Last updated
11/18/2021
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