Healthcare Provider Details

I. General information

NPI: 1992944417
Provider Name (Legal Business Name): CARRIE NAOMI DIEHL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARRIE STAIR

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 N MEDICAL DR E
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

175 N MEDICAL DR E
SALT LAKE CITY UT
84132-0001
US

V. Phone/Fax

Practice location:
  • Phone: 720-763-0499
  • Fax:
Mailing address:
  • Phone: 720-763-0499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number53219
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: