Basic Information
| Provider Information | |||||||||
| NPI: | 1639374374 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHURCH | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | GENE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8401 DATAPOINT DR STE 600 | ||||||||
| Address2: | P. O. BOX 29441 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782295907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106167796 | ||||||||
| FaxNumber: | 2106167799 | ||||||||
| Practice Location | |||||||||
| Address1: | 8401 DATAPOINT DR | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782295900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106167796 | ||||||||
| FaxNumber: | 2106167799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2007 | ||||||||
| LastUpdateDate: | 03/24/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | M0042 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085B0100X | M0042 | TX | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085D0003X | M0042 | TX | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Neuroimaging | 2085U0001X | M0042 | TX | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 2085N0700X | M0042 | TX | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | M0042 | TX | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085P0229X | M0042 | TX | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0204X | M0042 | TX | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | P00736456 | 01 | TX | RAILROAD MEDICARE | OTHER | 8L14244 | 01 | TX | MEDICARE - STRIC | OTHER | 2027005-01 | 05 | TX | MEDICAID | M0042 | 01 | TX | TEXAS MEDICAL BOARD | OTHER | 2027005-02 | 01 | TX | MEDICAID - CSHCN | OTHER | 2027005-03 | 01 | TX | MEDICAID - STRIC | OTHER | P00855904 | 01 | TX | RAILROAD MEDICARE | OTHER |