Provider Demographics
NPI:1053678342
Name:ABENROTH, DANIEL CLARK (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:CLARK
Last Name:ABENROTH
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 1:9TH FLOOR -- NEUROSCIENCES
Mailing Address - Street 2:190 E BANNOCK ST.
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-8905
Mailing Address - Country:US
Mailing Address - Phone:208-381-7335
Mailing Address - Fax:
Practice Address - Street 1:9TH FLOOR -- NEUROSCIENCES
Practice Address - Street 2:190 E BANNOCK ST.
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-8905
Practice Address - Country:US
Practice Address - Phone:208-381-7335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-136962084N0400X, 2084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology