Provider Demographics
NPI:1679885974
Name:DANIELSON, DAVID L (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:DANIELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 EAST BROADWAY
Mailing Address - Street 2:
Mailing Address - City:REDWOOD FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56283
Mailing Address - Country:US
Mailing Address - Phone:507-637-2985
Mailing Address - Fax:507-637-3057
Practice Address - Street 1:1100 EAST BROADWAY
Practice Address - Street 2:
Practice Address - City:REDWOOD FALLS
Practice Address - State:MN
Practice Address - Zip Code:56283
Practice Address - Country:US
Practice Address - Phone:507-637-2985
Practice Address - Fax:507-637-3057
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN56296207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine