Individual
MR. DANIEL MARTIN TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3751 SKYLINE DR, RAPID CITY, SD 57701-5363
(605) 341-7248
(605) 431-0268
Mailing address
3751 SKYLINE DR, RAPID CITY, SD 57701-5363
(605) 341-7248
(605) 431-0268
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
1894
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102240700
—
WY
05
—
7202112
—
SD
01
—
920002680
RAILROAD MEDICARE
—
Enumeration date
09/20/2005
Last updated
05/08/2017
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