Provider Demographics
NPI:1376888735
Name:MCCONNELL, DANIEL BRIAN JR (MSPA)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:BRIAN
Last Name:MCCONNELL
Suffix:JR
Gender:M
Credentials:MSPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 GARRITY BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-9222
Mailing Address - Country:US
Mailing Address - Phone:714-595-4110
Mailing Address - Fax:
Practice Address - Street 1:4301 GARRITY BLVD STE 103
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-9222
Practice Address - Country:US
Practice Address - Phone:714-595-4110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22731363AM0700X, 363AS0400X
IDPA-2063363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical