Healthcare Provider Details

I. General information

NPI: 1710914015
Provider Name (Legal Business Name): TODD CHARLES SEYMOUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 S COTTONWOOD STREET INTERMOUNTAIN MEDICAL CENTER
MURRAY UT
84157
US

IV. Provider business mailing address

3340 NORTH CENTER ST #800
LEHI UT
84043-7406
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-5248
  • Fax: 541-773-2027
Mailing address:
  • Phone: 801-990-1911
  • Fax: 541-773-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number24608
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: