MEDICARE: D MICHAEL EDSON 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
1	2085R0202X	Diagnostic Radiology Physician	149562-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811995814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	D MICHAEL EDSON MD

Provider Business Mailing Address
First Line	:	PO BOX 1169
Second Line	:
City	:	BOUNTIFUL
State	:	UT
Zip	:	84011-1169
Country	:	US
Telephone Number	:	801-296-2113
Fax Number	:	801-296-1715

Provider Business Practice Location Address
First Line	:	3460 PIONEER PKWY
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-2049
Country	:	US
Telephone Number	:	801-964-3100
Fax Number	:	801-296-1715

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	02/08/2026

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