Provider Demographics
NPI:1497250377
Name:MCDANIEL, CHARLES W (DO)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 35629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0629
Mailing Address - Country:US
Mailing Address - Phone:214-424-2200
Mailing Address - Fax:214-231-2159
Practice Address - Street 1:480 US HIGHWAY 80 E STE 200
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-9226
Practice Address - Country:US
Practice Address - Phone:214-327-2727
Practice Address - Fax:214-327-1394
Is Sole Proprietor?:No
Enumeration Date:2018-03-24
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXV0472207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty