Individual
DANIEL GERARDO IZQUIERDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
MARTIN ARMY COMMUNITY HOSPITAL, FORT BENNING, GA 31905
(706) 544-2258
Mailing address
2419 W SOUTHLAKE BLVD, STE 100, SOUTHLAKE, TX 76092-1506
(706) 610-5717
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
PA11409
TX
Other
Enumeration date
05/15/2007
Last updated
03/13/2019
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