Provider Demographics
NPI:1083675128
Name:OFFRET, DANIEL (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:OFFRET
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1757
Mailing Address - Country:US
Mailing Address - Phone:801-614-9030
Mailing Address - Fax:801-614-9040
Practice Address - Street 1:1550 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1757
Practice Address - Country:US
Practice Address - Phone:801-614-9030
Practice Address - Fax:801-614-9040
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-452363A00000X
UT263558-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME201836OtherNGS
ME035045OtherANTHEM
ME334510099Medicaid
ME334510099Medicaid
ME035045OtherANTHEM