Healthcare Provider Details

I. General information

NPI: 1003836636
Provider Name (Legal Business Name): JOSEPH J ALBANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6360 S 3000 E 210
SALT LAKE CITY UT
84121-6923
US

IV. Provider business mailing address

PO BOX 71547
SALT LAKE CITY UT
84171-0547
US

V. Phone/Fax

Practice location:
  • Phone: 385-220-9009
  • Fax:
Mailing address:
  • Phone: 385-220-9009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number2693081205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: