Healthcare Provider Details

I. General information

NPI: 1417096090
Provider Name (Legal Business Name): NATHAN DAVID JOOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 11/29/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S 900 E
SALT LAKE CITY UT
84105-3208
US

IV. Provider business mailing address

2000 S 900 E
SALT LAKE CITY UT
84105-3208
US

V. Phone/Fax

Practice location:
  • Phone: 801-464-7510
  • Fax:
Mailing address:
  • Phone: 801-464-7510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number13019723-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: