Provider Demographics
NPI:1619082468
Name:DANIEL, CHARLES PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:PAUL
Last Name:DANIEL
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 1:605 E SAN ANTONIO ST
Mailing Address - Street 2:STE 520E
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-6040
Mailing Address - Country:US
Mailing Address - Phone:361-576-0633
Mailing Address - Fax:361-576-0639
Practice Address - Street 1:605 E SAN ANTONIO ST
Practice Address - Street 2:STE 520E
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6040
Practice Address - Country:US
Practice Address - Phone:361-576-0633
Practice Address - Fax:361-576-0639
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4284207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099238004Medicaid
TX8A7049Medicare ID - Type Unspecified
TX099238004Medicaid