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NPI Code Detail

MEDICARE: DANIEL JOSEPH GRAY

MEDICARE: DANIEL JOSEPH GRAY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker11923845-3501UT

General Provider Information

NPI Number : 1043032923
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL JOSEPH GRAY
Provider Business Mailing Address
First Line : 2450 E FORT UNION BLVD
Second Line :
City : COTTONWOOD HEIGHTS
State : UT
Zip : 84121-3337
Country : US
Telephone Number : 801-669-5888
Fax Number : 801-669-5889
Provider Business Practice Location Address
First Line : 2450 E FORT UNION BLVD
Second Line :
City : COTTONWOOD HEIGHTS
State : UT
Zip : 84121-3337
Country : US
Telephone Number : 801-669-5888
Fax Number : 801-669-5889
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2024
Last Update Date : 10/30/2024

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