Provider Demographics
NPI:1316974660
Name:MUNDY, DANIEL O (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:O
Last Name:MUNDY
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 1:6410 FANNIN ST
Mailing Address - Street 2:#200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3000
Mailing Address - Country:US
Mailing Address - Phone:713-796-8334
Mailing Address - Fax:713-799-2708
Practice Address - Street 1:6410 FANNIN ST
Practice Address - Street 2:#200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3000
Practice Address - Country:US
Practice Address - Phone:713-796-8334
Practice Address - Fax:713-799-2708
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6611174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164738001Medicaid
TXF84784Medicare UPIN
TX8P0670Medicare ID - Type Unspecified