Provider Demographics
NPI:1427008507
Name:MCDANIEL, BENJAMIN GLASGOW JR (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:GLASGOW
Last Name:MCDANIEL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000A SOUTHBRIDGE PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7718
Mailing Address - Country:US
Mailing Address - Phone:205-871-4274
Mailing Address - Fax:205-871-4301
Practice Address - Street 1:1022 1ST ST N
Practice Address - Street 2:STE103
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8706
Practice Address - Country:US
Practice Address - Phone:205-621-3930
Practice Address - Fax:205-621-0998
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL000247632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51533592OtherBCBS AL
AL7216815OtherAETNA
AL515-33593OtherBLUE CROSS
ALP00334412OtherRRMC
AL515-33591OtherBLUE CROSS
AL515-33592OtherBLUE CROSS
AL51533592OtherBCBS AL