Healthcare Provider Details

I. General information

NPI: 1760499180
Provider Name (Legal Business Name): PAUL NORMAN DANIELS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1449 E 3300 S
SALT LAKE CITY UT
84106-3308
US

IV. Provider business mailing address

1449 E 3300 S
SALT LAKE CITY UT
84106-3308
US

V. Phone/Fax

Practice location:
  • Phone: 801-483-1015
  • Fax: 801-484-2875
Mailing address:
  • Phone: 801-483-1015
  • Fax: 801-484-2875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number103337-0501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number74
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: