Provider Demographics
NPI:1194750711
Name:DANIEL S. SELLERS M.D. LLC
Entity type:Organization
Organization Name:DANIEL S. SELLERS M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-295-6554
Mailing Address - Street 1:620 MEDICAL DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5084
Mailing Address - Country:US
Mailing Address - Phone:801-295-6554
Mailing Address - Fax:
Practice Address - Street 1:620 MEDICAL DR
Practice Address - Street 2:SUITE 310
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5084
Practice Address - Country:US
Practice Address - Phone:801-295-6554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT176560-12052082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT540648443016Medicaid
UT540648443016Medicaid