Healthcare Provider Details

I. General information

NPI: 1154410041
Provider Name (Legal Business Name): DANIEL JAMES BEQUILLARD PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CUT OFF RD STE 14
PORT ARANSAS TX
78373-4246
US

IV. Provider business mailing address

PSC 450 BOX 412
APO AP CA
96206
US

V. Phone/Fax

Practice location:
  • Phone: 361-749-1930
  • Fax: 361-749-1933
Mailing address:
  • Phone: 817-217-9029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: