Provider Demographics
NPI:1043214935
Name:DANIELS, JONATHAN PEARSON (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:PEARSON
Last Name:DANIELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 S ROXBURY RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2843
Mailing Address - Country:US
Mailing Address - Phone:801-505-3182
Mailing Address - Fax:
Practice Address - Street 1:82 S 1100 E STE 305
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-4703
Practice Address - Country:US
Practice Address - Phone:801-214-7650
Practice Address - Fax:801-214-7650
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17073207V00000X
CAC50108207V00000X
KS0429296207V00000X
UT73994128017207V00000X
UT7399412-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100398640BMedicaid
KS101740Medicare ID - Type Unspecified
KS100398640BMedicaid