Provider Demographics
NPI:1386844587
Name:WALZ, DANIELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:WALZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 NE LOOP 410 STE 245
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5650
Mailing Address - Country:US
Mailing Address - Phone:210-314-1122
Mailing Address - Fax:210-314-1109
Practice Address - Street 1:2455 NE LOOP 410 STE 245
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5650
Practice Address - Country:US
Practice Address - Phone:210-314-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB147059Medicare PIN
TXTXB147059Medicare UPIN