MEDICARE: DANIEL RICHARD THULL PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PENDING	TX

General Provider Information

NPI Number	:	1518168640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL RICHARD THULL PA-C

Provider Business Mailing Address
First Line	:	1355 E COURT ST
Second Line	:
City	:	SEGUIN
State	:	TX
Zip	:	78155-5130
Country	:	US
Telephone Number	:	830-401-4401
Fax Number	:	830-303-5225

Provider Business Practice Location Address
First Line	:	7207 WINTERWOOD PL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4171
Country	:	US
Telephone Number	:	210-316-9896
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	04/19/2016

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