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General NPI Number Information
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NPI Number | 1154359529
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Entity Type | Individual
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Provider Name | MARLA WEISSLER DUDAK M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 1220 E 3900 S STE 4I
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City | SALT LAKE CITY
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State | UT
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Zip | 84124-1383
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Country | US
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Telephone | 801-948-2380
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Fax |
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Provider Business Mailing Address
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Address Line | 3702 ASPEN PT
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City | PARK CITY
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State | UT
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Zip | 84098-4912
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Country | US
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Telephone | 561-706-0234
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME72788
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | ME72788
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 13143314-1205
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License Number State | UT
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