Provider Demographics
NPI:1801094487
Name:DANIEL GOLDSMITH M.D
Entity type:Organization
Organization Name:DANIEL GOLDSMITH M.D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-204-2540
Mailing Address - Street 1:120 NORTHVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5581
Mailing Address - Country:US
Mailing Address - Phone:928-204-2540
Mailing Address - Fax:928-204-9070
Practice Address - Street 1:120 NORTHVIEW RD
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5581
Practice Address - Country:US
Practice Address - Phone:928-204-2540
Practice Address - Fax:928-204-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ03D0948663OtherCLIA LAB ID
AZ03D0948663OtherCLIA LAB ID
AZBG0669842OtherDEA
AZE28051Medicare UPIN