Provider Demographics
NPI:1578506291
Name:CHAPMAN, DANE M (MD)
Entity Type:Individual
Prefix:DR
First Name:DANE
Middle Name:M
Last Name:CHAPMAN
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:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:SPRING CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84662-0039
Mailing Address - Country:US
Mailing Address - Phone:435-813-2624
Mailing Address - Fax:435-355-3688
Practice Address - Street 1:216 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING CITY
Practice Address - State:UT
Practice Address - Zip Code:84662-0039
Practice Address - Country:US
Practice Address - Phone:435-813-2624
Practice Address - Fax:435-355-3688
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5908503-1205208D00000X, 207P00000X
AZ30395207P00000X
CO27682207P00000X
MI4301089450207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5197400Medicaid
DC089450OtherBLUE CROSS BLUE SHIELD
P00419545OtherRAILROAD MEDICARE
P00419545OtherRAILROAD MEDICARE
MI5197400Medicaid
MI0M60540016Medicare Oscar/Certification