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NPI Code Detail

MEDICARE: DAVID GORDON AFFLECK MD

MEDICARE: DAVID GORDON AFFLECK 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
12086S0129XVascular Surgery Physician346120-1206UT
2208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery) Physician3461201205UT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00424176OTHERUTRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3134332141OTHERUTTAX IDENTIFICATION

General Provider Information

NPI Number : 1710979653
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID GORDON AFFLECK MD
Provider Business Mailing Address
First Line : PO BOX 281490
Second Line :
City : ATLANTA
State : GA
Zip : 30384-1490
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1160 E 3900 S
Second Line : SUITE 3500
City : SALT LAKE CITY
State : UT
Zip : 84124-1202
Country : US
Telephone Number : 801-743-4750
Fax Number : 801-743-4765
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2005
Last Update Date : 01/26/2022

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Directions to “ DAVID GORDON AFFLECK MD” Practice Location

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