Individual
DANIEL J HUMISTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
444 W BOURNE CIR STE 200, FARMINGTON, UT 84025
(801) 776-0174
(801) 825-3904
Mailing address
444 W BOURNE CIR STE 200, FARMINGTON, UT 84025-3657
(801) 397-3000
(801) 397-0455
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
276787-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477643179
GROUP NPI
UT
Enumeration date
09/14/2005
Last updated
06/13/2019
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