Provider Demographics
NPI:1649372657
Name:DANIEL G CORREDOR MD PA
Entity type:Organization
Organization Name:DANIEL G CORREDOR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:GUSTAVO
Authorized Official - Last Name:CORREDOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-494-2644
Mailing Address - Street 1:11929 W AIRPORT BLVD
Mailing Address - Street 2:STE 402
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-2451
Mailing Address - Country:US
Mailing Address - Phone:281-494-2644
Mailing Address - Fax:281-494-2650
Practice Address - Street 1:11929 W AIRPORT BLVD
Practice Address - Street 2:STE 402
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-2451
Practice Address - Country:US
Practice Address - Phone:281-494-2644
Practice Address - Fax:281-494-2650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9482207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0048RAOtherBCBS OF TEXAS
TX281926001Medicaid
TX281926001Medicaid
TXTXB115749Medicare PIN