Healthcare Provider Details

I. General information

NPI: 1396927786
Provider Name (Legal Business Name): CHARLES CANFIELD, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

897 S 300 W
OREM UT
84058-6792
US

IV. Provider business mailing address

897 S 300 W
OREM UT
84058-6792
US

V. Phone/Fax

Practice location:
  • Phone: 801-602-4256
  • Fax:
Mailing address:
  • Phone: 801-602-4256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES OLIN CANFIELD
Title or Position: PROVIDER
Credential: MD
Phone: 801-602-4256