Provider Demographics
NPI:1295997344
Name:MCDANIEL, JARRED (MD)
Entity type:Individual
Prefix:DR
First Name:JARRED
Middle Name:
Last Name:MCDANIEL
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:PO BOX 10095
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59719-0095
Mailing Address - Country:US
Mailing Address - Phone:406-577-2346
Mailing Address - Fax:866-404-8715
Practice Address - Street 1:300 N WILLSON AVE
Practice Address - Street 2:SUITE 300C
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3551
Practice Address - Country:US
Practice Address - Phone:406-577-2346
Practice Address - Fax:866-404-8715
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT279072086S0122X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTM011008204Medicare UPIN