MEDICARE: DR. ELAINE DANIAL DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	2203	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2203	OTHER	TX	STATE LICENSE

General Provider Information

NPI Number	:	1114367968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELAINE DANIAL DPM

Provider Business Mailing Address
First Line	:	PO BOX 690833
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78269-0833
Country	:	US
Telephone Number	:	210-540-4205
Fax Number	:	210-569-7712

Provider Business Practice Location Address
First Line	:	4334 N LOOP 1604 W STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-3485
Country	:	US
Telephone Number	:	210-540-4205
Fax Number	:	210-569-7712

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	07/31/2019

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