Healthcare Provider Details

I. General information

NPI: 1851563779
Provider Name (Legal Business Name): ADAM READ TAINTOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3860 JACKSON AVE STE 2
OGDEN UT
84403
US

IV. Provider business mailing address

3860 JACKSON AVE STE 2
OGDEN UT
84403-1979
US

V. Phone/Fax

Practice location:
  • Phone: 801-627-0515
  • Fax: 801-627-0517
Mailing address:
  • Phone: 801-627-0515
  • Fax: 801-627-0517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number7890794-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number7890794.1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number7890794-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: