Provider Demographics
NPI:1174705883
Name:PRICE, DANNY L (MD)
Entity type:Individual
Prefix:
First Name:DANNY
Middle Name:L
Last Name:PRICE
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 1:1350 E RICHARDS ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-6153
Mailing Address - Country:US
Mailing Address - Phone:903-531-9455
Mailing Address - Fax:903-526-3118
Practice Address - Street 1:1350 E RICHARDS ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-6153
Practice Address - Country:US
Practice Address - Phone:903-531-9455
Practice Address - Fax:903-526-3118
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6670208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126642106Medicaid
TX8G0389OtherBCBS OF TEXAS
TX752616977027OtherTRICARE
TX126642107OtherMEDICAID- CSCHN
TX126642106Medicaid
TX370009025Medicare PIN