Healthcare Provider Details

I. General information

NPI: 1346215266
Provider Name (Legal Business Name): DANIEL ROY CLANG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 W 20TH ST SUITE 101
GREELEY CO
80634
US

IV. Provider business mailing address

6801 W 20TH ST SUITE 101
GREELEY CO
80634
US

V. Phone/Fax

Practice location:
  • Phone: 970-378-8000
  • Fax: 970-378-8088
Mailing address:
  • Phone: 970-378-8000
  • Fax: 970-378-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number37040
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37040
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: