Provider Demographics
NPI:1962450916
Name:MACKAY, DANIEL ALEXANDER II (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALEXANDER
Last Name:MACKAY
Suffix:II
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 1:609 FURLONG DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-4128
Mailing Address - Country:US
Mailing Address - Phone:512-680-9300
Mailing Address - Fax:
Practice Address - Street 1:17080 DALLAS PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1968
Practice Address - Country:US
Practice Address - Phone:512-680-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7562207R00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104413303Medicaid
TX104413303Medicaid
TX84V208Medicare PIN