Provider Demographics
NPI:1083871412
Name:AZERRAD, DANNY DAVID (MD-CTN)
Entity Type:Individual
Prefix:DR
First Name:DANNY
Middle Name:DAVID
Last Name:AZERRAD
Suffix:
Gender:M
Credentials:MD-CTN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6516 ESCONDIDO DR
Mailing Address - Street 2:SUITE A7
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2971
Mailing Address - Country:US
Mailing Address - Phone:915-726-1988
Mailing Address - Fax:
Practice Address - Street 1:6516 ESCONDIDO DRIVE
Practice Address - Street 2:SUITE A7
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912
Practice Address - Country:US
Practice Address - Phone:915-726-1977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC10000713174400000X
CERT058361744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No1744R1102XOther Service ProvidersSpecialistResearch Study