Healthcare Provider Details

I. General information

NPI: 1639515869
Provider Name (Legal Business Name): DANIEL TAYLOR FRONK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 W BOURNE CIR STE 200
FARMINGTON UT
84025-3657
US

IV. Provider business mailing address

444 W BOURNE CIR STE 200
FARMINGTON UT
84025-3657
US

V. Phone/Fax

Practice location:
  • Phone: 801-776-0174
  • Fax: 801-825-3904
Mailing address:
  • Phone: 801-776-0174
  • Fax: 801-825-3904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number11732664-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: