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General NPI Number Information
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NPI Number | 1679763494
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Entity Type | Organization
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Legal Business Name | NATHAN W DAVIS DPM PC
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Dates
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Enumeration Date | 07/27/2007
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Last Update Date | 12/02/2009
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Provider Practice Location Address
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Address Line | 154 MYRTLE AVE SUITE 201
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City | MURRAY
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State | UT
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Zip | 84107-4849
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Country | US
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Telephone | 801-743-2909
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Fax | 801-288-9505
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Provider Business Mailing Address
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Address Line | 154 MYRTLE AVE SUITE 201
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City | MURRAY
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State | UT
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Zip | 84107-4849
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Country | US
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Telephone | 801-743-2909
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Fax | 801-288-9505
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | THIA HAMBLIN
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Credential |
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Telephone | 801-743-2909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 49208910501
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License Number State | UT
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