Provider Demographics
NPI:1053376475
Name:GILLETTE, DANIEL W (MD)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:W
Last Name:GILLETTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3549 SOUTHERN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4736
Mailing Address - Country:US
Mailing Address - Phone:712-274-6729
Mailing Address - Fax:712-274-6744
Practice Address - Street 1:3549 SOUTHERN HILLS DR
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4736
Practice Address - Country:US
Practice Address - Phone:712-274-6729
Practice Address - Fax:712-274-6744
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA331592084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F86803Medicare UPIN