Provider Demographics
NPI:1225030661
Name:MONAHAN, DANIEL CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:CHARLES
Last Name:MONAHAN
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 1:230 N HOSPITAL DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-4235
Mailing Address - Country:US
Mailing Address - Phone:435-637-7960
Mailing Address - Fax:435-637-2128
Practice Address - Street 1:230 N HOSPITAL DR
Practice Address - Street 2:SUITE 3
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-4235
Practice Address - Country:US
Practice Address - Phone:435-637-7960
Practice Address - Fax:435-637-2128
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT342941-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTC53853Medicare UPIN
UT000011942Medicare ID - Type UnspecifiedMEDICARE NUMBER