Healthcare Provider Details

I. General information

NPI: 1063693844
Provider Name (Legal Business Name): DONALD R CALL JR DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 W SOUTH JORDAN PKWY STE 105
SOUTH JORDAN UT
84095-9060
US

IV. Provider business mailing address

1325 W SOUTH JORDAN PKWY STE 105
SOUTH JORDAN UT
84095-9060
US

V. Phone/Fax

Practice location:
  • Phone: 801-254-3123
  • Fax: 801-254-3969
Mailing address:
  • Phone: 801-254-3123
  • Fax: 801-254-3969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number50881690501
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number50881690501
License Number StateUT

VIII. Authorized Official

Name: DONALD R CALL JR.
Title or Position: OWNER
Credential: DPM
Phone: 801-254-3123