MEDICARE: DR. O LAYTON ALLDREDGE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	161846-1205	UT

General Provider Information

NPI Number	:	1225144264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. O LAYTON ALLDREDGE M.D.

Provider Business Mailing Address
First Line	:	9720 SOUTH 1300 EAST
Second Line	:	W110
City	:	SANDY
State	:	UT
Zip	:	84094
Country	:	US
Telephone Number	:	801-571-9511
Fax Number	:	801-571-9823

Provider Business Practice Location Address
First Line	:	9720 SOUTH 1300 EAST
Second Line	:	W110
City	:	SANDY
State	:	UT
Zip	:	84094
Country	:	US
Telephone Number	:	801-571-9511
Fax Number	:	801-571-9823

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/09/2007

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