Healthcare Provider Details

I. General information

NPI: 1952861288
Provider Name (Legal Business Name): DANIEL PAYNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 S FOOTHILL DR
SLC UT
84109-4000
US

IV. Provider business mailing address

2295 S FOOTHILL DR
SLC UT
84109-4000
US

V. Phone/Fax

Practice location:
  • Phone: 801-486-3021
  • Fax:
Mailing address:
  • Phone: 801-486-3021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11837390-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: