Healthcare Provider Details

I. General information

NPI: 1316236698
Provider Name (Legal Business Name): DANIEL E HUMPHREYS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5475 S 500 E FL 1
OGDEN UT
84405-6905
US

IV. Provider business mailing address

333 N 300 W
SALT LAKE CITY UT
84103-1215
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-2111
  • Fax:
Mailing address:
  • Phone: 801-463-7415
  • Fax: 303-436-2710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01071385A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: