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NPI Code Detail

MEDICARE: JUSTIN F THULIN MD

MEDICARE: JUSTIN F THULIN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician3259971205UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
19311824424OTHERUTTAX ID NUMBER

General Provider Information

NPI Number : 1023057098
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN F THULIN MD
Provider Business Mailing Address
First Line : 1151 E 3900 S
Second Line : STE B259
City : SALT LAKE CTY
State : UT
Zip : 84124-1259
Country : US
Telephone Number : 801-266-7325
Fax Number : 801-281-2263
Provider Business Practice Location Address
First Line : 1151 E 3900 S
Second Line : PARKVIEW BUILDING B 259
City : SALT LAKE CITY
State : UT
Zip : 84124-1216
Country : US
Telephone Number : 801-266-7325
Fax Number : 801-281-2263
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2006
Last Update Date : 10/26/2007

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Directions to “ JUSTIN F THULIN MD” Practice Location

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