Basic Information
| Provider Information | |||||||||
| NPI: | 1043674856 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WORRELL | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | LOGAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 650823 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752650823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702627400 | ||||||||
| FaxNumber: | 9702627401 | ||||||||
| Practice Location | |||||||||
| Address1: | 68 SCHOOL RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | FRISCO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804430000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702627400 | ||||||||
| FaxNumber: | 9702627401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2016 | ||||||||
| LastUpdateDate: | 10/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 18963 | CA | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | DR.0069656 | CO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 9000209415 | 05 | CO | MEDICAID |