Provider Demographics
NPI:1376519330
Name:CUELLAR, DAVID CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CHARLES
Last Name:CUELLAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8240 N MOPAC EXPY STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8869
Mailing Address - Country:US
Mailing Address - Phone:512-687-1950
Mailing Address - Fax:512-407-9010
Practice Address - Street 1:16040 PARK VALLEY DR STE 111
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3596
Practice Address - Country:US
Practice Address - Phone:512-248-2200
Practice Address - Fax:512-248-1950
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2021-09-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL6335208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH57285OtherUPIN NUMBER
TX160137901Medicaid
TX45D0672417OtherCLIA NUMBER
TX45D0672417OtherCLIA NUMBER