Provider Demographics
NPI:1932160322
Name:VANDE LUNE, DANIEL WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WAYNE
Last Name:VANDE LUNE
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:PO BOX 12793
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79913-0793
Mailing Address - Country:US
Mailing Address - Phone:915-581-0712
Mailing Address - Fax:915-833-7312
Practice Address - Street 1:1400 GEORGE DIETER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7653
Practice Address - Country:US
Practice Address - Phone:915-581-0712
Practice Address - Fax:915-833-7312
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8803207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G41828Medicare UPIN
56651Medicare ID - Type Unspecified
IA0144683Medicaid