Healthcare Provider Details

I. General information

NPI: 1871971184
Provider Name (Legal Business Name): DARYL MCLAREN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 01/24/2026
Certification Date: 01/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 E HENNICK ST
PINEDALE WY
82941-5228
US

IV. Provider business mailing address

3499 E BOUGIVAL LN
SANDY UT
84093-1208
US

V. Phone/Fax

Practice location:
  • Phone: 307-367-4133
  • Fax:
Mailing address:
  • Phone: 385-321-0010
  • Fax:

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 Number10804029-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: