MEDICARE: DR. WILLIAM HARMON TETTELBACH MD

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	207RI0200X	Infectious Disease Physician	MD 37898	TN
2	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	351005-1205	UT
3	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	MD37898	TN
4	207RI0200X	Infectious Disease Physician	351005-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3510051205	OTHER	UT	UTAH LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336143361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM HARMON TETTELBACH MD

Provider Business Mailing Address
First Line	:	3810 LARIAT RD
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-4826
Country	:	US
Telephone Number	:	901-517-1889
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 E 4500 S STE 100
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-4057
Country	:	US
Telephone Number	:	385-533-8898
Fax Number	:

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	07/30/2025

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