Healthcare Provider Details

I. General information

NPI: 1063752855
Provider Name (Legal Business Name): MD ECF SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2942 S 2000 W
SYRACUSE UT
84075-8937
US

IV. Provider business mailing address

2942 S 2000 W
SYRACUSE UT
84075-8937
US

V. Phone/Fax

Practice location:
  • Phone: 801-664-2184
  • Fax:
Mailing address:
  • Phone: 801-664-2184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number7932637-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number7932637-1205
License Number StateUT

VIII. Authorized Official

Name: DENNIS PORTER LAW
Title or Position: OWNER
Credential: MD
Phone: 801-664-2184