Provider Demographics
NPI:1215676879
Name:DANIEL, BRYAN RANDALL
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:RANDALL
Last Name:DANIEL
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 1:2920 E 73RD ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5630
Mailing Address - Country:US
Mailing Address - Phone:539-525-3281
Mailing Address - Fax:
Practice Address - Street 1:2920 E 73RD ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5630
Practice Address - Country:US
Practice Address - Phone:539-525-3281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist