Healthcare Provider Details

I. General information

NPI: 1366368839
Provider Name (Legal Business Name): DANIEL ROBERT SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 36TH ST
OGDEN UT
84403-2111
US

IV. Provider business mailing address

1535 36TH ST
OGDEN UT
84403-2111
US

V. Phone/Fax

Practice location:
  • Phone: 760-525-6526
  • Fax:
Mailing address:
  • Phone: 760-525-6526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number11128372-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: