Provider Demographics
NPI:1760574776
Name:COTTAM, DANIEL RHEAD (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:RHEAD
Last Name:COTTAM
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 1:1046 E 100 SOUTH
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102
Mailing Address - Country:US
Mailing Address - Phone:801-746-2885
Mailing Address - Fax:702-384-8446
Practice Address - Street 1:1046 E 100 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1520
Practice Address - Country:US
Practice Address - Phone:801-746-2885
Practice Address - Fax:801-746-2886
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10997174400000X
UT6655906-1205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1760574776Medicaid
NV100503622Medicaid
NV10997OtherMD#
UT1760574776Medicaid
NV100503622Medicaid
UTH58271Medicare UPIN
UTU000074265Medicare PIN
NV10997OtherMD#