Provider Demographics
NPI:1760499180
Name:DANIELS, PAUL NORMAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:NORMAN
Last Name:DANIELS
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 1:1449 E 3300 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3308
Mailing Address - Country:US
Mailing Address - Phone:801-483-1015
Mailing Address - Fax:801-484-2875
Practice Address - Street 1:1449 E 3300 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3308
Practice Address - Country:US
Practice Address - Phone:801-483-1015
Practice Address - Fax:801-484-2875
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT103337-0501213ES0103X
WY74213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870372277OtherFEDERAL TAX ID
UT870372277OtherFEDERAL TAX ID
WYT77944Medicare UPIN
UT000001177Medicare ID - Type UnspecifiedUTAH MEDICARE NUMBER
UTT77944Medicare UPIN