Healthcare Provider Details

I. General information

NPI: 1811962939
Provider Name (Legal Business Name): RANDALL P DAYNES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 MURRAY HOLLADAY RD SUITE 207
SALT LAKE CITY UT
84117-4901
US

IV. Provider business mailing address

999 MURRAY HOLLADAY RD SUITE 207
SALT LAKE CITY UT
84117-4901
US

V. Phone/Fax

Practice location:
  • Phone: 801-268-2584
  • Fax: 801-262-1168
Mailing address:
  • Phone: 801-268-2584
  • Fax: 801-262-1168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1653701205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: