Healthcare Provider Details

I. General information

NPI: 1083675128
Provider Name (Legal Business Name): DANIEL OFFRET PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 N MAIN ST
LAYTON UT
84041-1757
US

IV. Provider business mailing address

1550 N MAIN ST
LAYTON UT
84041-1757
US

V. Phone/Fax

Practice location:
  • Phone: 801-614-9030
  • Fax: 801-614-9040
Mailing address:
  • Phone: 801-614-9030
  • Fax: 801-614-9040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-452
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number263558-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: