Healthcare Provider Details

I. General information

NPI: 1942303193
Provider Name (Legal Business Name): DANIEL JUAREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 MCCULLOUGH AVE STE. 248
SAN ANTONIO TX
78212-5609
US

IV. Provider business mailing address

PO BOX 847
SAN ANTONIO TX
78293-0847
US

V. Phone/Fax

Practice location:
  • Phone: 210-220-3737
  • Fax: 210-220-3747
Mailing address:
  • Phone: 210-220-3737
  • Fax: 210-220-3747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG0444
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: