Provider Demographics
NPI:1588600431
Name:MCCRIMONS, DANIEL EVERETT (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:EVERETT
Last Name:MCCRIMONS
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 1:5030 J ST
Mailing Address - Street 2:301
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3800
Mailing Address - Country:US
Mailing Address - Phone:916-451-8430
Mailing Address - Fax:916-451-3845
Practice Address - Street 1:77 CADILLAC DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-5453
Practice Address - Country:US
Practice Address - Phone:855-354-2242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47002208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G470020Medicaid
A50565Medicare UPIN