Healthcare Provider Details

I. General information

NPI: 1205871043
Provider Name (Legal Business Name): SHIRO FUJITA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SHIRO FUJITA

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 12/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5171 COTTONWOOD ST SUITE 650
MURRAY UT
84107-5704
US

IV. Provider business mailing address

5171 COTTONWOOD ST SUITE 650
MURRAY UT
84107-5704
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-9600
  • Fax: 801-507-9601
Mailing address:
  • Phone: 801-507-9600
  • Fax: 801-507-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number7365628-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: