Provider Demographics
NPI:1124074414
Name:GATLIN, DANIEL LEE (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LEE
Last Name:GATLIN
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 1:142 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:WEST SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-2511
Mailing Address - Country:US
Mailing Address - Phone:651-457-7171
Mailing Address - Fax:
Practice Address - Street 1:142 WESTCHESTER DR
Practice Address - Street 2:
Practice Address - City:WEST SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-2511
Practice Address - Country:US
Practice Address - Phone:651-457-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2016-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47204207P00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN034990900Medicaid
MN034990900Medicaid