Healthcare Provider Details

I. General information

NPI: 1649250283
Provider Name (Legal Business Name): DUSTIN GEORGE HUNTZINGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DUSTIN G HUNTZINGER MD

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 HARRISON BLVD
OGDEN UT
84403-4303
US

IV. Provider business mailing address

PO BOX 5546
DENVER CO
80217-5546
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-3011
  • Fax: 801-475-3001
Mailing address:
  • Phone: 801-475-3500
  • Fax: 801-475-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number375389-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: