Healthcare Provider Details

I. General information

NPI: 1225147283
Provider Name (Legal Business Name): DAVID L CORWIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MEDICAL DR
SLC UT
84113-1103
US

IV. Provider business mailing address

100 N MEDICAL DR
SLC UT
84113-1103
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-3600
  • Fax: 801-662-3610
Mailing address:
  • Phone: 801-662-3600
  • Fax: 801-662-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number3789651205
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: