Healthcare Provider Details

I. General information

NPI: 1205822061
Provider Name (Legal Business Name): DANIEL D. QUIGLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3370 S TEXAS AVE SUITE B
BRYAN TX
77802-3127
US

IV. Provider business mailing address

1500 UNIVERSITY DR E SUITE 100
COLLEGE STATION TX
77840-2600
US

V. Phone/Fax

Practice location:
  • Phone: 979-595-1700
  • Fax: 979-595-1740
Mailing address:
  • Phone: 979-846-1100
  • Fax: 979-260-9390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK3933
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: