Healthcare Provider Details

I. General information

NPI: 1114121787
Provider Name (Legal Business Name): DANIEL EATON HOWARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 01/06/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 CEDAR BEND DR AUSTIN DIAGNOSTIC CLINIC
AUSTIN TX
78758-5378
US

IV. Provider business mailing address

12221 N MO PAC EXPY
AUSTIN TX
78758-2401
US

V. Phone/Fax

Practice location:
  • Phone: 512-901-4016
  • Fax: 512-901-3857
Mailing address:
  • Phone: 512-901-4016
  • Fax: 512-901-3857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP1-0026859
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN3737
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: