Provider Demographics
NPI:1861221525
Name:DANIELS, MARQUISDERELL
Entity type:Individual
Prefix:
First Name:MARQUISDERELL
Middle Name:
Last Name:DANIELS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 FM 1679
Mailing Address - Street 2:
Mailing Address - City:ORE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75683
Mailing Address - Country:US
Mailing Address - Phone:405-628-9986
Mailing Address - Fax:
Practice Address - Street 1:12901 FM 1649
Practice Address - Street 2:
Practice Address - City:ORE CITY
Practice Address - State:TX
Practice Address - Zip Code:75683-6532
Practice Address - Country:US
Practice Address - Phone:405-628-9986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health