Healthcare Provider Details

I. General information

NPI: 1598005340
Provider Name (Legal Business Name): ON CALL DOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10437 S JORDAN GTWY
SOUTH JORDAN UT
84095-3915
US

IV. Provider business mailing address

63 E 11400 S # 317
SANDY UT
84070-6705
US

V. Phone/Fax

Practice location:
  • Phone: 801-877-0705
  • Fax: 801-335-5957
Mailing address:
  • Phone: 801-877-0705
  • Fax: 801-335-5957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES O CANFIELD
Title or Position: MD
Credential: MD
Phone: 801-877-0705