Provider Demographics
NPI:1821086406
Name:DALEY, PHILLIP G (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:G
Last Name:DALEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7401 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4509
Mailing Address - Country:US
Mailing Address - Phone:713-799-2300
Mailing Address - Fax:713-794-3380
Practice Address - Street 1:520 BLOSSOM ST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4210
Practice Address - Country:US
Practice Address - Phone:281-332-9537
Practice Address - Fax:281-332-1560
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-08
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD6407207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124596103Medicaid
TX124596103Medicaid
TXC14985Medicare UPIN