Provider Demographics
NPI:1780629840
Name:DACCAK, RUKAN (MD)
Entity Type:Individual
Prefix:
First Name:RUKAN
Middle Name:
Last Name:DACCAK
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:PO BOX 405
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77587-0405
Mailing Address - Country:US
Mailing Address - Phone:713-910-7779
Mailing Address - Fax:713-910-7760
Practice Address - Street 1:4450 E SAM HOUSTON PKWY S
Practice Address - Street 2:STE H2
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3950
Practice Address - Country:US
Practice Address - Phone:713-910-7779
Practice Address - Fax:713-910-7760
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8980207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0077ASOtherBCBSTX
TX096904002Medicaid
TX181878301OtherMEDICAID PIN
TX181878301OtherMEDICAID PIN
TX096904002Medicaid
TX8763B0Medicare PIN