Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 37040 | CO |
N | 207QA0505X | Family Doctor - Adult Medicine | 37040 | CO |
NPI | 1346215266 |
---|---|
Provider Name | Dr. Daniel Roy Clang |
First Address | Greeley, CO 80634 |
Second Address | Greeley, CO 80634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 10/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01370402 | (05) | CO |
G46259 | (02) |