1649372657 NPI number — DANIEL G CORREDOR MD PA

Table of content: (NPI 1649372657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649372657 NPI number — DANIEL G CORREDOR MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL G CORREDOR MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1649372657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11929 W AIRPORT BLVD
Provider Second Line Business Mailing Address:
STE 402
Provider Business Mailing Address City Name:
STAFFORD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77477-2451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-494-2644
Provider Business Mailing Address Fax Number:
281-494-2650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11929 W AIRPORT BLVD
Provider Second Line Business Practice Location Address:
STE 402
Provider Business Practice Location Address City Name:
STAFFORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77477-2451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-494-2644
Provider Business Practice Location Address Fax Number:
281-494-2650
Provider Enumeration Date:
09/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CORREDOR
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
GUSTAVO
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
281-494-2644

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  E9482 , 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: 0048RA . This is a "BCBS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 281926001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com