MEDICARE: DR. PAUL NORMAN DANIELS DPM

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
1	213ES0103X	Foot & Ankle Surgery Podiatrist	103337-0501	UT
2	213ES0103X	Foot & Ankle Surgery Podiatrist	74	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	870372277	OTHER	UT	FEDERAL TAX ID

General Provider Information

NPI Number	:	1760499180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL NORMAN DANIELS DPM

Provider Business Mailing Address
First Line	:	1449 E 3300 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3308
Country	:	US
Telephone Number	:	801-483-1015
Fax Number	:	801-484-2875

Provider Business Practice Location Address
First Line	:	1449 E 3300 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3308
Country	:	US
Telephone Number	:	801-483-1015
Fax Number	:	801-484-2875

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/09/2007

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