Healthcare Provider Details

I. General information

NPI: 1184723165
Provider Name (Legal Business Name): DAVID NILS LOFGREN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 E 9400 S SUITE 100
SANDY UT
84093-2957
US

IV. Provider business mailing address

1434 E 9400 S SUITE 100
SANDY UT
84093-2957
US

V. Phone/Fax

Practice location:
  • Phone: 801-572-9369
  • Fax: 801-572-9677
Mailing address:
  • Phone: 801-572-9369
  • Fax: 801-572-9677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1754741205
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: