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General NPI Number Information
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NPI Number | 1063777449
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Entity Type | Organization
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Legal Business Name | DAN K. EIDMAN, MDPA
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 07/11/2012
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Provider Practice Location Address
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Address Line | 6624 FANNIN ST STE 1510 6624 FANNIN, STE 1510
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City | HOUSTON
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State | TX
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Zip | 77030-2393
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Country | US
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Telephone | 713-796-8595
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Fax | 713-796-0813
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Provider Business Mailing Address
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Address Line | 6624 FANNIN ST STE 1510 6624 FANNIN, STE 1510
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City | HOUSTON
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State | TX
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Zip | 77030-2393
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Country | US
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Telephone | 713-796-8595
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Fax | 713-796-0813
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Authorized Official
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Title or Position | CEO
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Name | DAN EIDMAN
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Credential |
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Telephone | 713-796-8595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | E4316
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License Number State | TX
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