Healthcare Provider Details

I. General information

NPI: 1043255201
Provider Name (Legal Business Name): DANIEL DEATON PRIMM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE K401
LEXINGTON KY
40536-0208
US

IV. Provider business mailing address

740 S LIMESTONE K401
LEXINGTON KY
40536-0208
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5533
  • Fax: 859-323-2412
Mailing address:
  • Phone: 859-323-5533
  • Fax: 859-323-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number19618
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number19618
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: