MEDICARE: FREDERIC ZACHARY ODDONE DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	14203649-0501	UT

General Provider Information

NPI Number	:	1881326981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERIC ZACHARY ODDONE DPM

Provider Business Mailing Address
First Line	:	1220 E 3900 S STE 4D
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1383
Country	:	US
Telephone Number	:	801-269-9939
Fax Number	:	801-405-7695

Provider Business Practice Location Address
First Line	:	1220 E 3900 S STE 4D
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1383
Country	:	US
Telephone Number	:	801-269-9939
Fax Number	:	801-405-7695

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

Provider Enumeration Date	:	06/28/2022
Last Update Date	:	07/07/2025

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