Healthcare Provider Details

I. General information

NPI: 1396374997
Provider Name (Legal Business Name): NATHAN DREYFUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HELIX: 30 N MARIO CAPECDAI DR RM 2S200
SALT LAKE CITY UT
84112
US

IV. Provider business mailing address

HELIX: 30 N MARIO CAPECDAI DR RM 2S200
SALT LAKE CITY UT
84112
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number13870025-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number13870025-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: