MEDICARE: DAN K. EIDMAN, MDPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	E4316	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063777449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAN K. EIDMAN, MDPA

Provider Business Mailing Address
First Line	:	6624 FANNIN ST STE 1510
Second Line	:	6624 FANNIN, STE 1510
City	:	HOUSTON
State	:	TX
Zip	:	77030-2393
Country	:	US
Telephone Number	:	713-796-8595
Fax Number	:	713-796-0813

Provider Business Practice Location Address
First Line	:	6624 FANNIN ST STE 1510
Second Line	:	6624 FANNIN, STE 1510
City	:	HOUSTON
State	:	TX
Zip	:	77030-2393
Country	:	US
Telephone Number	:	713-796-8595
Fax Number	:	713-796-0813

Authorized Official
Title or Position	:	CEO
Name	:	DAN EIDMAN
Credential	:
Telephone Number	:	713-796-8595

Provider Enumeration Date	:	07/11/2012
Last Update Date	:	07/11/2012

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