Provider Demographics
NPI:1316087042
Name:KATZ, DANIEL M (DO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:M
Last Name:KATZ
Suffix:
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11667
Mailing Address - Street 2:SUITE B1
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98508-1667
Mailing Address - Country:US
Mailing Address - Phone:360-705-1015
Mailing Address - Fax:360-705-1313
Practice Address - Street 1:405 BLACK HILLS LN SW
Practice Address - Street 2:SUITE B1
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8661
Practice Address - Country:US
Practice Address - Phone:360-705-1015
Practice Address - Fax:360-705-1313
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2017-02-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAOP00001704207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA84-1677925OtherTAX ID NUMBER
WA84-1677925OtherTAX ID NUMBER
WAG90905Medicare UPIN