Provider Demographics
NPI:1801187323
Name:DANIEL A. DEANE, MD, PA
Entity Type:Organization
Organization Name:DANIEL A. DEANE, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-614-4448
Mailing Address - Street 1:7922 EWING HALSELL DR
Mailing Address - Street 2:STE 260
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3786
Mailing Address - Country:US
Mailing Address - Phone:210-614-4448
Mailing Address - Fax:210-579-2179
Practice Address - Street 1:7922 EWING HALSELL DR
Practice Address - Street 2:STE 260
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3786
Practice Address - Country:US
Practice Address - Phone:210-614-4448
Practice Address - Fax:210-579-2179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-02
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK92532080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0039WNOtherBCBS OF TX
TX124617507Medicaid
TX124617507Medicaid