Provider Demographics
NPI:1972584050
Name:DANIELS, BRUCE ALAN (MD)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ALAN
Last Name:DANIELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRUCE
Other - Middle Name:ALAN
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4221 S WESTERN AVE
Mailing Address - Street 2:STE 4045
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3447
Mailing Address - Country:US
Mailing Address - Phone:405-636-1166
Mailing Address - Fax:405-632-8446
Practice Address - Street 1:4221 S WESTERN AVE
Practice Address - Street 2:STE 4045
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3447
Practice Address - Country:US
Practice Address - Phone:405-636-1166
Practice Address - Fax:405-632-8446
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10948207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100100150AMedicaid