Individual
DR. RENNY THEODORE MCDANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., M.P.H.
Contact information
Practice address
15 S 1000 E STE 100, PAYSON, UT 84651-5592
(801) 465-9480
Mailing address
325 W CENTER ST, SPANISH FORK, UT 84660-2060
(801) 798-7301
(801) 798-8513
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10738150-1205
UT
207Q00000X
Family Medicine Physician
Q4631
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
348324001
—
TX
Enumeration date
03/29/2012
Last updated
03/21/2019
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