Provider Demographics
NPI:1184771347
Name:CANCHOLA, DANIEL RAMIRO (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:RAMIRO
Last Name:CANCHOLA
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 1:7200 STATE HIGHWAY 161 STE 300
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3831
Mailing Address - Country:US
Mailing Address - Phone:972-443-5300
Mailing Address - Fax:972-432-0498
Practice Address - Street 1:7200 STATE HIGHWAY 161 STE 300
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3831
Practice Address - Country:US
Practice Address - Phone:972-443-5300
Practice Address - Fax:972-432-0498
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME112104207Q00000X
CT49540207Q00000X
CA54537207Q00000X
ARE-10703207Q00000X
TXK7137207Q00000X
NMTM2010-0736207Q00000X
NC2011-00164207Q00000X
MO2010042080207Q00000X
MN1458207Q00000X
MI4301097537207Q00000X
MA249804207Q00000X
KY44505207Q00000X
IN07078685A207Q00000X
IL036128916207Q00000X
GA065528207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0434728OtherSTATE MEDICAL LICENSE
TX124189506Medicaid
IL036128916OtherSTATE MEDICAL LICENSE
OK32869OtherSTATE MEDICAL LICENSE
SDMD10238OtherSTATE MEDICAL LICENSE
TX124189507Medicaid
OH35.096267OtherSTATE MEDICAL LICENSE
VA0101250406OtherSTATE MEDICAL LICENSE
UT7792324-1205OtherSTATE MEDICAL LICENSE
PAMD441759OtherSTATE MEDICAL LICENSE
WV24737OtherSTATE MEDICAL LICENSE
MS25691OtherSTATE MEDICAL LICENSE
TN55352OtherSTATE MEDICAL LICENSE