MEDICARE: DR. DANIEL OWEN THOMPSON MD

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	207Q00000X	Family Medicine Physician	3713101205	UT

General Provider Information

NPI Number	:	1831186717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL OWEN THOMPSON MD

Provider Business Mailing Address
First Line	:	1756 PARK AVE
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-4701
Country	:	US
Telephone Number	:	801-254-0309
Fax Number	:	801-254-1012

Provider Business Practice Location Address
First Line	:	1756 PARK AVE
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-4701
Country	:	US
Telephone Number	:	801-254-0309
Fax Number	:	801-254-1012

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

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	07/08/2007

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