Provider Demographics
NPI:1881441863
Name:SMITH-MAGOON, DANIEL FREDERICK (RDN, LD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:FREDERICK
Last Name:SMITH-MAGOON
Suffix:
Gender:M
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9212 SPIRE VW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-4692
Mailing Address - Country:US
Mailing Address - Phone:210-667-3251
Mailing Address - Fax:
Practice Address - Street 1:9212 SPIRE VW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-4692
Practice Address - Country:US
Practice Address - Phone:210-667-3251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86047484133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered