Provider Demographics
NPI:1396993614
Name:DANIELS, BRYANT DEWAYNE SR
Entity type:Individual
Prefix:MR
First Name:BRYANT
Middle Name:DEWAYNE
Last Name:DANIELS
Suffix:SR
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 1:8035 E R L THORNTON FWY STE 518G
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-7063
Mailing Address - Country:US
Mailing Address - Phone:214-607-2009
Mailing Address - Fax:
Practice Address - Street 1:8035 E R L THORNTON FWY STE 518G
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-7063
Practice Address - Country:US
Practice Address - Phone:214-607-2009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0106050332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies