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General NPI Number Information
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NPI Number | 1013283449
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Entity Type | Individual
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Provider Name | RENNY THEODORE MCDANIEL M.D., M.P.H.
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Gender | Male
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 03/21/2019
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Provider Practice Location Address
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Address Line | 15 S 1000 E STE 100
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City | PAYSON
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State | UT
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Zip | 84651-5592
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Country | US
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Telephone | 801-465-9480
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Fax |
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Provider Business Mailing Address
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Address Line | 325 W CENTER ST
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City | SPANISH FORK
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State | UT
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Zip | 84660-2060
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Country | US
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Telephone | 801-798-7301
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Fax | 801-798-8513
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | Q4631
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 10738150-1205
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License Number State | UT
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