Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | E9482 | TX |
NPI | 1003906512 |
---|---|
Provider Name | Daniel G Corredor |
First Address | Stafford, TX 77477-2451 |
Second Address | Stafford, TX 77477-2451 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 26/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
111600604 | (05) | TX |
88W393 | BCBS OF TEXAS (01) | TX |
A73788 | (02) | TX |
E9482 | TEXAS MEDICAL LICENSE (01) | TX |