MEDICARE: RUKAN DACCAK 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	207RG0100X	Gastroenterology Physician	J8980	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0077AS	OTHER	TX	BCBSTX
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780629840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUKAN DACCAK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 405
Second Line	:
City	:	SOUTH HOUSTON
State	:	TX
Zip	:	77587-0405
Country	:	US
Telephone Number	:	713-910-7779
Fax Number	:	713-910-7760

Provider Business Practice Location Address
First Line	:	4450 E SAM HOUSTON PKWY S
Second Line	:	STE H2
City	:	PASADENA
State	:	TX
Zip	:	77505-3950
Country	:	US
Telephone Number	:	713-910-7779
Fax Number	:	713-910-7760

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

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	05/25/2011

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