MEDICARE: DAVID PAUL DORSEY

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
1	207LC0200X	Critical Care Medicine (Anesthesiology) Physician	9649544-1205	UT

General Provider Information

NPI Number	:	1417248022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID PAUL DORSEY

Provider Business Mailing Address
First Line	:	734 23RD ST SW
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98371-8702
Country	:	US
Telephone Number	:	253-686-5703
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 N 1900 E
Second Line	:	ROOM 3C444
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-2501
Country	:	US
Telephone Number	:	801-581-6393
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2011
Last Update Date	:	10/20/2021

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Directions to “ DAVID PAUL DORSEY ” Practice Location

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