Provider Demographics
NPI:1366490666
Name:DANIEL, CHARLES J JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:DANIEL
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W PARK DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1469
Mailing Address - Country:US
Mailing Address - Phone:970-245-3338
Mailing Address - Fax:970-245-9499
Practice Address - Street 1:201 W PARK DR
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1469
Practice Address - Country:US
Practice Address - Phone:970-245-3338
Practice Address - Fax:970-245-9499
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO486213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1366490666OtherRAILROAD MEDICARE
CO01004860Medicaid
CO480019197OtherRAILROAD MEDICARE
CO1366490666OtherNPI
CO1720207863OtherNPI GROUP
CO1720207863OtherNPI GROUP
CO1366490666OtherRAILROAD MEDICARE
CO01004860Medicaid