Provider Demographics
NPI:1386629574
Name:GARLITOS, DANIEL RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:RAY
Last Name:GARLITOS
Suffix:
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 1:2610 W. SAM HOUSTON PKWY SOUTH
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042
Mailing Address - Country:US
Mailing Address - Phone:713-343-6750
Mailing Address - Fax:713-952-9664
Practice Address - Street 1:100B MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5674
Practice Address - Country:US
Practice Address - Phone:979-297-9268
Practice Address - Fax:979-297-9331
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK77422085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029882004Medicaid
TX1590473-01OtherMEDICAID GROUP
TX00251TOtherGROUP MEDICARE PIN
TX1590648-01OtherMEDICAID GROUP
TX00250TOtherGROUP MEDICARE PIN
TX8BP367OtherBCBS
TX029882005Medicaid
TXP00695492OtherRAILROAD MEDICARE
TX8J9112Medicare PIN
TX8BP367OtherBCBS
TX00251TOtherGROUP MEDICARE PIN
TX029882005Medicaid
TX8K1157Medicare PIN