Provider Demographics
NPI:1104969310
Name:ZOETEMAN, DANIEL TODD (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:TODD
Last Name:ZOETEMAN
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 1:7550 N 19TH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-7980
Mailing Address - Country:US
Mailing Address - Phone:602-995-5909
Mailing Address - Fax:602-864-9233
Practice Address - Street 1:7550 N 19TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-7980
Practice Address - Country:US
Practice Address - Phone:602-995-5909
Practice Address - Fax:602-864-9233
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ37203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine