Provider Demographics
NPI:1902978000
Name:MCDANIEL, ROYLAN JAMES (MD)
Entity Type:Individual
Prefix:
First Name:ROYLAN
Middle Name:JAMES
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 S TUCKER AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-6619
Mailing Address - Country:US
Mailing Address - Phone:620-231-2490
Mailing Address - Fax:620-231-3920
Practice Address - Street 1:2401 S TUCKER AVE STE 4
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-6619
Practice Address - Country:US
Practice Address - Phone:620-231-2490
Practice Address - Fax:620-231-3920
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS20755208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100201960AMedicaid
KSD05293Medicare UPIN
KS003312Medicare ID - Type Unspecified