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General NPI Number Information
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NPI Number | 1205803897
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Entity Type | Individual
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Provider Name | SHAWN DALE ISAEFF M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/02/2006
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 5974 FASHION POINT DR STE 110
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City | OGDEN
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State | UT
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Zip | 84403-4712
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Country | US
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Telephone | 801-917-2270
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Fax |
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Provider Business Mailing Address
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Address Line | 5974 FASHION POINT DR STE 110
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City | OGDEN
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State | UT
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Zip | 84403-4712
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Country | US
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Telephone | 801-917-2270
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Fax | 661-200-7783
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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 | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | C55447
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD34076
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 24914
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License Number State | OK
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