Healthcare Provider Details

I. General information

NPI: 1942568118
Provider Name (Legal Business Name): DANIEL PRIOR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 N LIBERTY ST STE 300
BOISE ID
83704
US

IV. Provider business mailing address

3340 E GOLDSTONE DR
MERIDIAN ID
83642
US

V. Phone/Fax

Practice location:
  • Phone: 208-302-2300
  • Fax: 208-302-2900
Mailing address:
  • Phone: 208-302-2300
  • Fax: 208-302-2900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberH84622
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number26696205
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberO-1290
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: