Provider Demographics
NPI:1588645931
Name:JULIAN, DANNY SEAN (MD)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:SEAN
Last Name:JULIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9510 CASA GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:WOODWAY
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6481
Mailing Address - Country:US
Mailing Address - Phone:254-723-3915
Mailing Address - Fax:
Practice Address - Street 1:2100 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-1271
Practice Address - Country:US
Practice Address - Phone:254-755-0088
Practice Address - Fax:254-755-6695
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5574207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152262501Medicaid
TX116307304Medicaid
TX00508TMedicare ID - Type UnspecifiedGROUP MEDICARE #
TXG83636Medicare UPIN
TX152262501Medicaid