Healthcare Provider Details

I. General information

NPI: 1497263750
Provider Name (Legal Business Name): MARC DANIEL ANESTHESIA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17980 DALLAS PARKWAY
DALLAS TX
75287
US

IV. Provider business mailing address

5207 MILAM ST
DALLAS TX
75206
US

V. Phone/Fax

Practice location:
  • Phone: 972-913-7715
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberQ1605
License Number StateTX

VIII. Authorized Official

Name: DR. MARC DANIEL GALLAND
Title or Position: OWNER
Credential: DO
Phone: 580-220-9887