Provider Demographics
NPI:1043255201
Name:PRIMM, DANIEL DEATON (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DEATON
Last Name:PRIMM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:740 S LIMESTONE
Mailing Address - Street 2:K401
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0208
Mailing Address - Country:US
Mailing Address - Phone:859-323-5533
Mailing Address - Fax:859-323-2412
Practice Address - Street 1:740 S LIMESTONE
Practice Address - Street 2:K401
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0208
Practice Address - Country:US
Practice Address - Phone:859-323-5533
Practice Address - Fax:859-323-2412
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY19618204C00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYD82696OtherUPIN
KY64196181Medicaid
KY64196181Medicaid