Individual
DANIEL JACK MEULENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
606 N 3RD AVE STE 101, SANDPOINT, ID 83864-1594
(208) 263-1435
(208) 263-7812
Mailing address
606 N 3RD AVE STE 101, SANDPOINT, ID 83864-1594
(208) 263-5527
(208) 263-4580
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M5882
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002792600
—
ID
Enumeration date
06/30/2005
Last updated
01/22/2020
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