MEDICARE: DR. DANIEL RHEAD COTTAM M.D.

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	174400000X	Specialist	10997	NV
2	208600000X	Surgery Physician	6655906-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	10997	OTHER	NV	MD#

General Provider Information

NPI Number	:	1760574776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL RHEAD COTTAM M.D.

Provider Business Mailing Address
First Line	:	1046 E 100 SOUTH
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102
Country	:	US
Telephone Number	:	801-746-2885
Fax Number	:	702-384-8446

Provider Business Practice Location Address
First Line	:	1046 E 100 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1520
Country	:	US
Telephone Number	:	801-746-2885
Fax Number	:	801-746-2886

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	01/10/2022

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