Provider Demographics
NPI:1376542654
Name:DSOUZA, DANIEL KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:KEITH
Last Name:DSOUZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1500 S DAIRY ASHFORD RD STE 197A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-3858
Mailing Address - Country:US
Mailing Address - Phone:281-870-8282
Mailing Address - Fax:281-870-8299
Practice Address - Street 1:1500 S DAIRY ASHFORD RD STE 197A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-3858
Practice Address - Country:US
Practice Address - Phone:281-870-8282
Practice Address - Fax:281-870-8299
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE50642Medicare UPIN
TX8F4172Medicare PIN