Healthcare Provider Details

I. General information

NPI: 1811135981
Provider Name (Legal Business Name): TIMOTHY ROBERT DANCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E 3900 S
SALT LAKE CITY UT
84124-1300
US

IV. Provider business mailing address

3445 E 3020 S
SALT LAKE CITY UT
84109-4219
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2121
  • Fax:
Mailing address:
  • Phone: 801-463-4863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number7470020-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number39
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: