Provider Demographics
NPI:1902163025
Name:NOLAN, DANIEL P (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:NOLAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9157 HUEBNER RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1502
Mailing Address - Country:US
Mailing Address - Phone:231-557-7092
Mailing Address - Fax:210-558-7679
Practice Address - Street 1:9157 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1502
Practice Address - Country:US
Practice Address - Phone:210-697-2020
Practice Address - Fax:210-558-7679
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXR3566207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX373372701Medicaid