Provider Demographics
NPI:1518168640
Name:THULL, DANIEL RICHARD (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:RICHARD
Last Name:THULL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:DAN
Other - Middle Name:
Other - Last Name:THULL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1355 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5130
Mailing Address - Country:US
Mailing Address - Phone:830-401-4401
Mailing Address - Fax:830-303-5225
Practice Address - Street 1:7207 WINTERWOOD PL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4171
Practice Address - Country:US
Practice Address - Phone:210-316-9896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPENDING363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant