Basic Information
| Provider Information | |||||||||
| NPI: | 1881037448 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COELHO | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | TAVARES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6210 E HWY 290 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787231142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124839596 | ||||||||
| FaxNumber: | 5124066216 | ||||||||
| Practice Location | |||||||||
| Address1: | 11714 WILSON PARKE AVE STE 150 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787264061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123466611 | ||||||||
| FaxNumber: | 5124066267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2013 | ||||||||
| LastUpdateDate: | 09/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 281387-1 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | S8971 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 424947601 | 05 | TX | MEDICAID | 424947602 | 05 | TX | MEDICAID |