Healthcare Provider Details

I. General information

NPI: 1588600431
Provider Name (Legal Business Name): DANIEL EVERETT MCCRIMONS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CADILLAC DR
SACRAMENTO CA
95825-5453
US

IV. Provider business mailing address

5030 J ST 301
SACRAMENTO CA
95819-3800
US

V. Phone/Fax

Practice location:
  • Phone: 855-354-2242
  • Fax:
Mailing address:
  • Phone: 916-451-8430
  • Fax: 916-451-3845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG47002
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: