Provider Demographics
NPI:1255886271
Name:ZERULL, DANIEL S I (ABO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:S
Last Name:ZERULL
Suffix:I
Gender:M
Credentials:ABO
Other - Prefix:DR
Other - First Name:ANTHONY
Other - Middle Name:MICHAEL
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1197 EMME WAY
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-6956
Mailing Address - Country:US
Mailing Address - Phone:385-355-1077
Mailing Address - Fax:
Practice Address - Street 1:1197 EMME WAY
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-6956
Practice Address - Country:US
Practice Address - Phone:385-355-5107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT102X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1255886271OtherNPI