Provider Demographics
NPI:1376585802
Name:DANCEL, FEDERICO L JR (MD)
Entity Type:Individual
Prefix:
First Name:FEDERICO
Middle Name:L
Last Name:DANCEL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 JAMES BOWIE DR
Mailing Address - Street 2:SUITE A107
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-3357
Mailing Address - Country:US
Mailing Address - Phone:281-422-2398
Mailing Address - Fax:281-420-3824
Practice Address - Street 1:1610 JAMES BOWIE DR
Practice Address - Street 2:SUITE A107
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-3357
Practice Address - Country:US
Practice Address - Phone:281-422-2398
Practice Address - Fax:281-420-3824
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1314197-04Medicaid
TX1314197-04Medicaid
TX00D04FMedicare ID - Type Unspecified