Individual
DANIEL SPENCER MADSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4700 LAS VEGAS BLVD N, LAS VEGAS, NV 89191-6600
(702) 653-2840
Mailing address
2265 E SUNNYSIDE RD, IDAHO FALLS, ID 83404-7598
(208) 542-5000
(208) 542-5151
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
37113
AZ
2085R0202X
Diagnostic Radiology Physician
5384574-1205
UT
2085R0204X
Vascular & Interventional Radiology Physician
12595A
WY
2085R0204X
Vascular & Interventional Radiology Physician
M14927
ID
2085R0204X
Vascular & Interventional Radiology Physician
MED-PHYS-LIC-80205
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104998137
—
ID
05
—
1104998137
—
MT
Enumeration date
11/14/2006
Last updated
03/13/2020
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