Individual
DR. THEODORE DAKE JR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
310 STAGECOACH TRL, SUITE 300, SAN MARCOS, TX 78666-5134
(512) 392-3398
(512) 392-2890
Mailing address
310 STAGECOACH TRL, SUITE 300, SAN MARCOS, TX 78666-5134
(512) 392-3398
(512) 392-2890
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
E9594
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8M0870
BLUE CROSS BLUE SHIELD
TX
Enumeration date
08/23/2005
Last updated
07/08/2007
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