Healthcare Provider Details

I. General information

NPI: 1578829917
Provider Name (Legal Business Name): DANIEL PATRICK DONATO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-8840
US

IV. Provider business mailing address

PO BOX 650859 DEPT 710
DALLAS TX
75265-8840
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-0504
  • Fax:
Mailing address:
  • Phone: 409-747-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberT1683
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: