Provider Demographics
NPI:1265535405
Name:DANIEL JUAREZ, MD PA
Entity type:Organization
Organization Name:DANIEL JUAREZ, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-220-3737
Mailing Address - Street 1:PO BOX 847
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78293-0847
Mailing Address - Country:US
Mailing Address - Phone:210-220-3737
Mailing Address - Fax:210-220-3747
Practice Address - Street 1:1303 MCCULLOUGH AVE
Practice Address - Street 2:STE. 248
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5609
Practice Address - Country:US
Practice Address - Phone:210-220-3737
Practice Address - Fax:210-220-3747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0027KVOtherBC/BS
TX00869VMedicare ID - Type Unspecified