Provider Demographics
NPI:1528063005
Name:DANIELL, RANDY C (MD)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:C
Last Name:DANIELL
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:PO BOX 1198
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-1198
Mailing Address - Country:US
Mailing Address - Phone:325-670-4220
Mailing Address - Fax:325-670-4040
Practice Address - Street 1:1924 PINE ST
Practice Address - Street 2:SUITE 401A
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2451
Practice Address - Country:US
Practice Address - Phone:325-670-4000
Practice Address - Fax:325-670-4008
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6558174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033316301Medicaid
TX033316301Medicaid
TX00FG32Medicare PIN