Healthcare Provider Details

I. General information

NPI: 1609258433
Provider Name (Legal Business Name): DANIEL NEUMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5682 S 3500 W
ROY UT
84067
US

IV. Provider business mailing address

2086 N ROBINS DR STE C
LAYTON UT
84041-1183
US

V. Phone/Fax

Practice location:
  • Phone: 801-773-8644
  • Fax:
Mailing address:
  • Phone: 801-927-1558
  • Fax: 801-927-1591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125067233
License Number StateIL

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: