Healthcare Provider Details

I. General information

NPI: 1538023882
Provider Name (Legal Business Name): DVORA HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8180 S 700 E STE 130
SANDY UT
84070-0568
US

IV. Provider business mailing address

8180 S 700 E STE 130
SANDY UT
84070-0568
US

V. Phone/Fax

Practice location:
  • Phone: 801-407-9409
  • Fax: 801-341-9794
Mailing address:
  • Phone: 801-407-9409
  • Fax: 801-341-9794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: COLBY HADERLIE
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential:
Phone: 801-407-9409