Healthcare Provider Details

I. General information

NPI: 1275589699
Provider Name (Legal Business Name): DAVID DEWILE POOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 S STATE ROAD 46
TERRE HAUTE IN
47803-9781
US

IV. Provider business mailing address

5126 W DAYBREAK PKWY
SOUTH JORDAN UT
84095-5994
US

V. Phone/Fax

Practice location:
  • Phone: 812-232-0564
  • Fax:
Mailing address:
  • Phone: 801-213-4500
  • Fax: 801-213-5368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5684661-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01088904A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: