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General NPI Number Information
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NPI Number | 1588620413
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Entity Type | Individual
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Provider Name | TAZEEM A AIZAD M.D;
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Gender | Male
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 1561 W 7000 S STE # 202
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City | WEST JORDAN
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State | UT
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Zip | 84084-3556
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Country | US
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Telephone | 801-569-8344
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Fax | 801-569-9150
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Provider Business Mailing Address
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Address Line | 1561 W 7000 S STE # 202
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City | WEST JORDAN
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State | UT
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Zip | 84084-3556
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Country | US
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Telephone | 801-569-8344
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Fax | 801-569-9150
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 1757871205
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License Number State | UT
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