MEDICARE: PAUL N DANIELS DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	103337-0501	UT

General Provider Information

NPI Number	:	1265919914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL N DANIELS DPM

Provider Business Mailing Address
First Line	:	1449 E 3300 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3308
Country	:	US
Telephone Number	:	801-483-1015
Fax Number	:	801-553-9562

Provider Business Practice Location Address
First Line	:	1449 E 3300 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3308
Country	:	US
Telephone Number	:	801-483-1015
Fax Number	:	801-553-9562

Authorized Official
Title or Position	:	OFFICE MGR
Name	:	JEANETTE BIGGERS
Credential	:
Telephone Number	:	801-483-1015

Provider Enumeration Date	:	07/25/2018
Last Update Date	:	07/25/2018

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