Healthcare Provider Details

I. General information

NPI: 1861594624
Provider Name (Legal Business Name): DONALD R CALL JR. D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

1325 W SOUTH JORDAN PKWY SUITE 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 TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5088169-0501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number5088169-0501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: