Provider Demographics
NPI:1801981147
Name:CLUTE, DANIEL JONATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JONATHAN
Last Name:CLUTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6017 N 68TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-1006
Mailing Address - Country:US
Mailing Address - Phone:402-455-7240
Mailing Address - Fax:
Practice Address - Street 1:2331 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-1348
Practice Address - Country:US
Practice Address - Phone:402-434-7177
Practice Address - Fax:402-434-7180
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22714207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEI21023Medicare UPIN