MEDICARE: DAVID ROBERT BOETTGER M.D.

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	208000000X	Pediatrics Physician	1723311205	TX

General Provider Information

NPI Number	:	1811937006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ROBERT BOETTGER M.D.

Provider Business Mailing Address
First Line	:	6333 CRESTMOUNT CIR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-6350
Country	:	US
Telephone Number	:	801-572-6700
Fax Number	:	801-572-6700

Provider Business Practice Location Address
First Line	:	9720 S 1300 E
Second Line	:	W120
City	:	SANDY
State	:	UT
Zip	:	84094-3712
Country	:	US
Telephone Number	:	801-572-6700
Fax Number	:	801-572-6700

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	05/31/2011

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Directions to “ DAVID ROBERT BOETTGER M.D.” Practice Location

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