Healthcare Provider Details

I. General information

NPI: 1184807208
Provider Name (Legal Business Name): AARON EUGENE FRODSHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4624 S HOLLADAY BLVD SUITE 202
SALT LAKE CITY UT
84117-7054
US

IV. Provider business mailing address

4624 S HOLLADAY BLVD SUITE 202
SALT LAKE CITY UT
84117-7054
US

V. Phone/Fax

Practice location:
  • Phone: 801-810-2999
  • Fax: 801-407-0747
Mailing address:
  • Phone: 801-810-2999
  • Fax: 801-407-0747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number309974-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number309974-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: