Healthcare Provider Details

I. General information

NPI: 1508399809
Provider Name (Legal Business Name): SIMON ANTHONY MARTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

HELIX BUILDING 5050 30 N MARIO CAPECCHI DRIVE
SALT LAKE CITY UT
84112-9049
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2121
  • Fax:
Mailing address:
  • Phone: 801-581-6393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number14188239-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number14188239-8905
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: