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General NPI Number Information
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NPI Number | 1093990012
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Entity Type | Organization
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Legal Business Name | DAVID D. POOR
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 5746 W 13400 S
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City | HERRIMAN
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State | UT
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Zip | 84096-6907
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Country | US
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Telephone | 801-253-4001
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Fax | 801-253-4003
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Provider Business Mailing Address
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Address Line | 5746 W 13400 S
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City | HERRIMAN
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State | UT
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Zip | 84096-6907
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Country | US
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Telephone | 801-253-4001
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Fax | 801-253-4003
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. MICHAEL J PETERSON
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Credential | M.D.
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Telephone | 801-253-4001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5684661-1205
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License Number State | UT
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