Healthcare Provider Details

I. General information

NPI: 1407933708
Provider Name (Legal Business Name): JOHN THATCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

1128 E 1700 S
SALT LAKE CITY UT
84105-3522
US

V. Phone/Fax

Practice location:
  • Phone: 801-339-2239
  • Fax:
Mailing address:
  • Phone: 801-486-6371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5766636-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: