MEDICARE: DAVID DOUGLAS KUNZ

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	363L00000X	Nurse Practitioner	76011	ID

General Provider Information

NPI Number	:	1508098310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID DOUGLAS KUNZ

Provider Business Mailing Address
First Line	:	6405 S 3000 E STE 201
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-6990
Country	:	US
Telephone Number	:	801-266-3113
Fax Number	:	801-266-5633

Provider Business Practice Location Address
First Line	:	3360 WASHINGTON PKWY STE 2
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-8333
Country	:	US
Telephone Number	:	208-932-7024
Fax Number	:	208-904-4447

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

Provider Enumeration Date	:	08/12/2009
Last Update Date	:	02/05/2024

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