Basic Information
| Provider Information | |||||||||
| NPI: | 1336536143 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONDIE | ||||||||
| FirstName: | DANIEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5310 HARVEST HILL RD | ||||||||
| Address2: | STE 290 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752305826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2144200650 | ||||||||
| FaxNumber: | 2147360512 | ||||||||
| Practice Location | |||||||||
| Address1: | 3530 S VAL VISTA DR # B109 | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852977318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809058485 | ||||||||
| FaxNumber: | 4809057274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2015 | ||||||||
| LastUpdateDate: | 07/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ND0101X | S0650 | TX | N | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery | 207N00000X | S0650 | TX | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.