| Daniels Family Medical Center Llc | |
|
3736 N Market St Suite 100 Shreveport LA 71107-3104 | |
| (318) 934-0082 | |
| Not Available |
| Full Name | Daniels Family Medical Center Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3736 N Market St, Shreveport, Louisiana |
| Authorized Official Name and Position | Larry Clyde Daniels (OWNER, SOLE MEMBER) |
| Authorized Official Contact | 3189340082 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Daniels Family Medical Center Llc Po Box 7276 Shreveport LA 71137-7276 Ph: (318) 934-0082 | Daniels Family Medical Center Llc 3736 N Market St Suite 100 Shreveport LA 71107-3104 Ph: (318) 934-0082 |
| NPI Number | 1053594507 |
|---|---|
| Provider Enumeration Date | 12/06/2007 |
| Last Update Date | 12/12/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053594507 | NPI | - | NPPES |
| 1352896 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 06282R (Louisiana) | Primary |
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