Provider Demographics
NPI:1114367968
Name:DANIAL, ELAINE (DPM)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
Last Name:DANIAL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 690833
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78269-0833
Mailing Address - Country:US
Mailing Address - Phone:210-540-4205
Mailing Address - Fax:210-569-7712
Practice Address - Street 1:4334 N LOOP 1604 W STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3485
Practice Address - Country:US
Practice Address - Phone:210-540-4205
Practice Address - Fax:210-569-7712
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2203213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2203OtherSTATE LICENSE