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General NPI Number Information
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NPI Number | 1780563171
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Entity Type | Individual
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Provider Name | ALISTAIR GUMMOW MB BCHIR FRCR
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Gender | Male
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Dates
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Enumeration Date | 08/29/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 30 NORTH MEDICAL DRIVE DEPARTMENT OF RADIOLOGY
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City | SALT LAKE CITY
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State | UT
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Zip | 84132-0001
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Country | US
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Telephone | 801-213-2789
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Fax |
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Provider Business Mailing Address
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Address Line | 30 NORTH MARIO CAPECCHI DRIVE
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City | SALT LAKE CITY
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State | UT
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Zip | 84112
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Country | US
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Telephone | 801-213-2789
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 14212689-1251
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License Number State | UT
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