Healthcare Provider Details

I. General information

NPI: 1336401470
Provider Name (Legal Business Name): DANIEL GERARDO CANAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NW 11TH ST STE E33
HERMISTON OR
97838-8604
US

IV. Provider business mailing address

600 NW 11TH ST STE E33
HERMISTON OR
97838-8604
US

V. Phone/Fax

Practice location:
  • Phone: 541-667-3740
  • Fax: 541-303-8743
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD179526
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier500721498
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: