Provider Demographics
NPI:1801907308
Name:FIELDS, DANIEL J (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:FIELDS
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 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:9279 LOCUST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:CA
Practice Address - Zip Code:95669
Practice Address - Country:US
Practice Address - Phone:209-245-6968
Practice Address - Fax:209-245-5135
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42280207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G422800Medicaid
CA00G422800Medicaid
A48896Medicare UPIN
CA00G422801Medicare PIN