Provider Demographics
NPI:1568469856
Name:POLANCO, DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:POLANCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7430 REMCON CIR
Mailing Address - Street 2:BLDG A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3514
Mailing Address - Country:US
Mailing Address - Phone:915-584-0051
Mailing Address - Fax:915-833-1114
Practice Address - Street 1:7430 REMCON CIR
Practice Address - Street 2:BLDG A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3514
Practice Address - Country:US
Practice Address - Phone:915-584-0051
Practice Address - Fax:915-833-1114
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL2557207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145983603Medicaid
TX1459836-02Medicaid
TXTXB154608OtherWELLMED PTAN
TX8707B9OtherMEDICARE
TX1459836-02Medicaid