Provider Demographics
NPI:1720309685
Name:YELFIMOV, DANIEL ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALBERTO
Last Name:YELFIMOV
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 1:7909 FREDERICKSBURG ROAD, SUITE 110
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3400
Mailing Address - Country:US
Mailing Address - Phone:210-614-4544
Mailing Address - Fax:210-679-3713
Practice Address - Street 1:7909 FREDERICKSBURG ROAD SUITE 130
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3400
Practice Address - Country:US
Practice Address - Phone:210-614-4544
Practice Address - Fax:210-679-3713
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ4550208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP01088498OtherMEDICARE RAILROAD
MNP01088498OtherMEDICARE RAILROAD