Provider Demographics
NPI:1528220753
Name:DAYNES, JACOB WOODRUFF (DO)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:WOODRUFF
Last Name:DAYNES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:21693 SUNNYVIEW ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-2880
Mailing Address - Country:US
Mailing Address - Phone:586-948-8466
Mailing Address - Fax:
Practice Address - Street 1:1929 AARON DR STE L
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-8112
Practice Address - Country:US
Practice Address - Phone:435-843-3859
Practice Address - Fax:435-228-0130
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101017892207X00000X
UT3093355-1204207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty