1174589378 NPI number — DANNY MICHAEL KOFOS M.D.

Table of content: DANNY MICHAEL KOFOS M.D. (NPI 1174589378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174589378 NPI number — DANNY MICHAEL KOFOS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOFOS
Provider First Name:
DANNY
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174589378
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8109 FREDERICKSBURG RD
Provider Second Line Business Mailing Address:
PHYSICIAN PRACTICE SERVICES
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229-3311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-575-6919
Provider Business Mailing Address Fax Number:
210-575-4013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7700 FLOYD CURL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-3902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-575-6919
Provider Business Practice Location Address Fax Number:
210-575-4013
Provider Enumeration Date:
04/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  K8266 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0203X , with the licence number: K8266 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 105043711 TRAD , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105043712 CSN , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8DL540 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 103923500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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