Provider Demographics
NPI:1558372664
Name:MIJARES, DANIEL W (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:W
Last Name:MIJARES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:SUITE C-623
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2571
Mailing Address - Country:US
Mailing Address - Phone:972-692-9607
Mailing Address - Fax:877-722-7085
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:SUITE C-623
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2571
Practice Address - Country:US
Practice Address - Phone:972-692-9607
Practice Address - Fax:877-722-7085
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL3754207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH57236Medicare UPIN
TX279565YPHFMedicare PIN
TX00898NMedicare ID - Type Unspecified