Healthcare Provider Details

I. General information

NPI: 1235169921
Provider Name (Legal Business Name): DAVID D. POOR M.D. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5746 W 13400 S
HERRIMAN UT
84065-6907
US

IV. Provider business mailing address

5746 W 13400 S
HERRIMAN UT
84065-6907
US

V. Phone/Fax

Practice location:
  • Phone: 801-253-4001
  • Fax: 801-253-4001
Mailing address:
  • Phone: 801-253-4001
  • Fax: 801-253-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number5684661-1205
License Number StateUT

VIII. Authorized Official

Name: MISS MANDY HONEY ALLRED
Title or Position: CLINIC MANAGER
Credential:
Phone: 801-253-4001