Provider Demographics
NPI:1346295698
Name:STICKLER, DANIEL L II (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:STICKLER
Suffix:II
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 1:3353 TUSCANY DR
Mailing Address - Street 2:
Mailing Address - City:DRIFTWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78619-2056
Mailing Address - Country:US
Mailing Address - Phone:512-560-3694
Mailing Address - Fax:
Practice Address - Street 1:3353 TUSCANY DR
Practice Address - Street 2:
Practice Address - City:DRIFTWOOD
Practice Address - State:TX
Practice Address - Zip Code:78619-2056
Practice Address - Country:US
Practice Address - Phone:512-560-3694
Practice Address - Fax:828-330-4985
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME144084208D00000X
NC2011-01840208D00000X
TXS4397208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7300018000Medicaid
WV7300018000Medicaid