Healthcare Provider Details

I. General information

NPI: 1558372664
Provider Name (Legal Business Name): DANIEL W MIJARES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 FOREST LN SUITE C-623
DALLAS TX
75230-2571
US

IV. Provider business mailing address

7777 FOREST LN SUITE C-623
DALLAS TX
75230-2571
US

V. Phone/Fax

Practice location:
  • Phone: 972-692-9607
  • Fax: 877-722-7085
Mailing address:
  • Phone: 972-692-9607
  • Fax: 877-722-7085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL3754
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: