Provider Demographics
NPI:1154410041
Name:BEQUILLARD, DANIEL JAMES (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JAMES
Last Name:BEQUILLARD
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:PSC 450 BOX 412
Mailing Address - Street 2:
Mailing Address - City:APO AP
Mailing Address - State:CA
Mailing Address - Zip Code:96206
Mailing Address - Country:US
Mailing Address - Phone:817-217-9029
Mailing Address - Fax:
Practice Address - Street 1:600 CUT OFF RD STE 14
Practice Address - Street 2:
Practice Address - City:PORT ARANSAS
Practice Address - State:TX
Practice Address - Zip Code:78373-4246
Practice Address - Country:US
Practice Address - Phone:361-749-1930
Practice Address - Fax:361-749-1933
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1038252OtherNCCPA NUMBER