MEDICARE: DR. DANEEQUE J WOOLFOLK M.D.

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	207N00000X	Dermatology Physician	Q3314	TX

General Provider Information

NPI Number	:	1285927269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANEEQUE J WOOLFOLK M.D.

Provider Business Mailing Address
First Line	:	4520 N MACARTHUR BLVD STE 100
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-1235
Country	:	US
Telephone Number	:	214-630-5256
Fax Number	:

Provider Business Practice Location Address
First Line	:	4520 N MACARTHUR BLVD STE 100
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-1235
Country	:	US
Telephone Number	:	214-630-5256
Fax Number	:	214-630-2251

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

Provider Enumeration Date	:	05/24/2011
Last Update Date	:	04/17/2025

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