MEDICARE: DR. TRACI L. DAVID 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	2084P0804X	Child & Adolescent Psychiatry Physician	179001-1205	UT

General Provider Information

NPI Number	:	1437297272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACI L. DAVID M.D.

Provider Business Mailing Address
First Line	:	PO BOX 413076
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84141-3076
Country	:	US
Telephone Number	:	801-213-3900
Fax Number	:	801-585-3655

Provider Business Practice Location Address
First Line	:	650 S KOMAS DR STE 200
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1241
Country	:	US
Telephone Number	:	801-585-3828
Fax Number	:

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	12/19/2013

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