MEDICARE: DR. CHRISTOPHER DEA 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	2083X0100X	Occupational Medicine Physician	7148472-1205	UT

General Provider Information

NPI Number	:	1376797258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER DEA M.D.

Provider Business Mailing Address
First Line	:	391 CHIPETA WAY
Second Line	:	SUITE C
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1263
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	391 CHIPETA WAY
Second Line	:	SUITE C
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1263
Country	:	US
Telephone Number	:	801-581-2121
Fax Number	:

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

Provider Enumeration Date	:	11/05/2008
Last Update Date	:	11/05/2008

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