Provider Demographics
NPI:1194789883
Name:MADSEN, DAN FREDERICK (MD)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:FREDERICK
Last Name:MADSEN
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 1:2100 REGIONAL MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-9719
Mailing Address - Country:US
Mailing Address - Phone:979-532-1700
Mailing Address - Fax:979-532-6796
Practice Address - Street 1:2100 REGIONAL MEDICAL DR
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-9719
Practice Address - Country:US
Practice Address - Phone:979-532-1700
Practice Address - Fax:979-532-6796
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6897207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119168606Medicaid
TX887915OtherBC/BS TX#
TX040006014OtherRAILROAD GBA - RAILROAD MEDICARE
TXMDF6897TXOtherWORKERS COMPENSATION
TXP01090504OtherRAILROAD MEDICARE PTAN
TX119168603Medicaid
TX8DE536OtherBC/BS #
TX887915Medicare ID - Type Unspecified
TX119168603Medicaid
TX119168606Medicaid