Provider Demographics
NPI:1679890701
Name:HARWELL, DANIEL MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MARTIN
Last Name:HARWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6802 S OLYMPIA AVE
Mailing Address - Street 2:SUITE #300
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-1826
Mailing Address - Country:US
Mailing Address - Phone:918-749-0762
Mailing Address - Fax:918-744-4246
Practice Address - Street 1:6802 S OLYMPIA AVE
Practice Address - Street 2:SUITE #300
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-1826
Practice Address - Country:US
Practice Address - Phone:918-749-0762
Practice Address - Fax:918-744-4246
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301109314207T00000X
OH0000000390200000X
OK32880207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200715920AMedicaid