Provider Demographics
NPI:1942224779
Name:DANIELS, JEFFREY A (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:DANIELS
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 1:100 BEAVERHEAD TRAIL
Mailing Address - Street 2:PO BOX 160609
Mailing Address - City:BIG SKY
Mailing Address - State:MT
Mailing Address - Zip Code:59716-0609
Mailing Address - Country:US
Mailing Address - Phone:406-995-2797
Mailing Address - Fax:406-995-2965
Practice Address - Street 1:100 BEAVERHEAD TRAIL
Practice Address - Street 2:
Practice Address - City:BIG SKY
Practice Address - State:MT
Practice Address - Zip Code:59716-0609
Practice Address - Country:US
Practice Address - Phone:406-995-2797
Practice Address - Fax:406-995-2965
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7420208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT08041OtherBLUE CROSS ID #
MT08041OtherBLUE CROSS ID #