Healthcare Provider Details

I. General information

NPI: 1780701862
Provider Name (Legal Business Name): DAVID C NUTTALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N 1220 E SUITE 1
AMERICAN FORK UT
84003-2089
US

IV. Provider business mailing address

120 N 1220 E SUITE 1
AMERICAN FORK UT
84003-2089
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-6092
  • Fax: 801-756-5458
Mailing address:
  • Phone: 801-756-6092
  • Fax: 801-756-5458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number168496-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: