Healthcare Provider Details

I. General information

NPI: 1154359529
Provider Name (Legal Business Name): MARLA WEISSLER DUDAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E 3900 S STE 4I
SALT LAKE CITY UT
84124-1383
US

IV. Provider business mailing address

3702 ASPEN PT
PARK CITY UT
84098-4912
US

V. Phone/Fax

Practice location:
  • Phone: 801-948-2380
  • Fax:
Mailing address:
  • Phone: 561-706-0234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME72788
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberME72788
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number13143314-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: