Basic Information
| Provider Information | |||||||||
| NPI: | 1326409772 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOATES | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | MAX | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2575 CALANQUES TER | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890440462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024895318 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 802 S JACKSON AVE STE 505 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741279060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187475322 | ||||||||
| FaxNumber: | 9187467604 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2016 | ||||||||
| LastUpdateDate: | 03/14/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.