Provider Demographics
NPI:1417066564
Name:EGAN, DANIEL W (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:W
Last Name:EGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:155 W CANYON CREST RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-1819
Mailing Address - Country:US
Mailing Address - Phone:801-763-9851
Mailing Address - Fax:801-763-9852
Practice Address - Street 1:155 W CANYON CREST RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ALPINE
Practice Address - State:UT
Practice Address - Zip Code:84004-1819
Practice Address - Country:US
Practice Address - Phone:801-763-9851
Practice Address - Fax:801-763-9852
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT3460321205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD4750Medicaid
UTD4750Medicaid
UTG76816Medicare UPIN