Provider Demographics
NPI:1619005840
Name:DANO, JACULEEN ANN (MD)
Entity Type:Individual
Prefix:
First Name:JACULEEN
Middle Name:ANN
Last Name:DANO
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 1:1600 W 38TH ST
Mailing Address - Street 2:SUITE 315
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6400
Mailing Address - Country:US
Mailing Address - Phone:512-302-4047
Mailing Address - Fax:512-419-9717
Practice Address - Street 1:1600 W 38TH ST
Practice Address - Street 2:SUITE 315
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6400
Practice Address - Country:US
Practice Address - Phone:512-302-4047
Practice Address - Fax:512-419-9717
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4761207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0051DROtherBCBS ID
TX00396JMedicare ID - Type Unspecified
TXF73064Medicare UPIN