Healthcare Provider Details

I. General information

NPI: 1811151558
Provider Name (Legal Business Name): DAVID SPENCER DARLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 01/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N 300 W SUITE 401
PROVO UT
84604-3344
US

IV. Provider business mailing address

1055 N 300 W SUITE 401
PROVO UT
84604-3344
US

V. Phone/Fax

Practice location:
  • Phone: 801-357-7499
  • Fax: 801-373-5980
Mailing address:
  • Phone: 801-357-7499
  • Fax: 801-373-5980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number359419-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: