Provider Demographics
NPI:1285740365
Name:DANIELS, JOHN ALAN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ALAN
Last Name:DANIELS
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 1:50 TRUXTON CT
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36093-3296
Mailing Address - Country:US
Mailing Address - Phone:334-202-7858
Mailing Address - Fax:
Practice Address - Street 1:200 W LORAIN ST
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1026
Practice Address - Country:US
Practice Address - Phone:440-775-9105
Practice Address - Fax:440-775-9140
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051110207ZF0201X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology