Healthcare Provider Details

I. General information

NPI: 1417248022
Provider Name (Legal Business Name): DAVID PAUL DORSEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N 1900 E ROOM 3C444
SALT LAKE CITY UT
84132-2501
US

IV. Provider business mailing address

734 23RD ST SW
PUYALLUP WA
98371-8702
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-6393
  • Fax:
Mailing address:
  • Phone: 253-686-5703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number9649544-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: