Provider Demographics
NPI:1639306889
Name:PREECE, DANIEL L (DPM)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:PREECE
Suffix:
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 1:430 N 400 W
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-1229
Mailing Address - Country:US
Mailing Address - Phone:801-532-1822
Mailing Address - Fax:801-532-7544
Practice Address - Street 1:430 N 400 W
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-1229
Practice Address - Country:US
Practice Address - Phone:801-532-1822
Practice Address - Fax:801-532-7544
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7720998 0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1639306889Medicaid
U000076355OtherMEDICARE PTAN FOR SALT LAKE PODIATRY CENTER