Provider Demographics
NPI:1396038071
Name:COULTER, DANIELLE KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:KAY
Last Name:COULTER
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 1:8522 BROADWAY ST STE 111
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-6377
Mailing Address - Country:US
Mailing Address - Phone:210-293-1700
Mailing Address - Fax:210-293-1701
Practice Address - Street 1:8522 BROADWAY ST STE 111
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6377
Practice Address - Country:US
Practice Address - Phone:210-293-1700
Practice Address - Fax:210-293-1701
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXP7094208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program