Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301095945 | MI |
N | 111NI0900X | Internist | 4301095945 | MI |
N | 207RH0000X | Hematologist | 4301095945 | MI |
N | 207RH0003X | Hematology & Oncology | 42445 | TN |
N | 207RH0003X | Hematology & Oncology | 4301095945 | MI |
Y | 207RH0003X | Hematology & Oncology | 9455685-1205 | UT |
N | 207RX0202X | Medical Oncology | 4301095945 | MI |
NPI | 1275627309 |
---|---|
Provider Name | Daniel Ricardo Couriel |
First Address | Salt Lake City, UT 84112-5550 |
Second Address | Salt Lake City, UT 84112-5550 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 12/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3000532 | (05) | TN |
4156129 | BCBS TN (01) | TN |
G63591 | (02) | |
G63591 | (02) | MI |