Provider Demographics
NPI:1003906512
Name:CORREDOR, DANIEL G (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:G
Last Name:CORREDOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:G
Other - Last Name:CORREDOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11929 W AIRPORT BLVD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-2451
Mailing Address - Country:US
Mailing Address - Phone:281-494-2644
Mailing Address - Fax:281-494-2650
Practice Address - Street 1:11929 W AIRPORT BLVD
Practice Address - Street 2:SUITE 402
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-2451
Practice Address - Country:US
Practice Address - Phone:281-494-2644
Practice Address - Fax:281-494-2650
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9482207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88W393OtherBCBS OF TEXAS
TXE9482OtherTEXAS MEDICAL LICENSE
TX111600604Medicaid
TXE9482OtherTEXAS MEDICAL LICENSE
TXTXB115750Medicare PIN
TXA73788Medicare UPIN