Healthcare Provider Details

I. General information

NPI: 1245083245
Provider Name (Legal Business Name): RACHEL DAUM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N. MARIO CAPECCHI DRIVE
SALT LAKE CITY UT
84112
US

IV. Provider business mailing address

30 N. MARIO CAPECCHI DRIVE
SALT LAKE CITY UT
84112
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-7514
  • Fax:
Mailing address:
  • Phone: 801-581-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number14253276-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: