Provider Demographics
NPI:1821175407
Name:DANIEL, THOMAS M (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:DANIEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1000 HERITAGE CENTER CIR STE 122
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-4463
Mailing Address - Country:US
Mailing Address - Phone:512-906-0168
Mailing Address - Fax:512-906-0158
Practice Address - Street 1:1000 HERITAGE CENTER CIR STE 122
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-4463
Practice Address - Country:US
Practice Address - Phone:512-906-0168
Practice Address - Fax:512-906-0158
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD5953207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00AA94OtherBLUE CROSS ID NUMBER
TX74-2182210OtherTAX ID NUMBER
TX00AA94Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION
TX74-2182210OtherTAX ID NUMBER