Provider Demographics
NPI:1831191956
Name:COLTON, DANNY M (MD, MPH, FICS)
Entity type:Individual
Prefix:DR
First Name:DANNY
Middle Name:M
Last Name:COLTON
Suffix:
Gender:M
Credentials:MD, MPH, FICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17868 OUTER HIGHWAY 18
Mailing Address - Street 2:SUITE # 211
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1267
Mailing Address - Country:US
Mailing Address - Phone:760-810-0992
Mailing Address - Fax:
Practice Address - Street 1:15366 ELEVENTH ST STE Q
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3726
Practice Address - Country:US
Practice Address - Phone:442-327-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74120207QA0401X, 2083P0011X, 208D00000X, 208VP0000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A741200Medicaid
CA00A741200Medicare ID - Type Unspecified
CA00A741200Medicaid