Provider Demographics
NPI:1679927800
Name:QUAN, DAN
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:QUAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4477 S LAMAR BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1589
Mailing Address - Country:US
Mailing Address - Phone:512-892-9231
Mailing Address - Fax:
Practice Address - Street 1:4477 S LAMAR BLVD STE 400
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1589
Practice Address - Country:US
Practice Address - Phone:512-892-9231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10055840208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics