Healthcare Provider Details

I. General information

NPI: 1508223686
Provider Name (Legal Business Name): DAVID DRAPER C.P.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 E FAIRFAX RD
SALT LAKE CITY UT
84103-4324
US

IV. Provider business mailing address

417 S ROOSTER HOLW
KAYSVILLE UT
84037-2228
US

V. Phone/Fax

Practice location:
  • Phone: 801-536-3820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: