MEDICARE: DR. DOUGLAS C DILLON 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	207P00000X	Emergency Medicine Physician	EC-05-085	ME
2	207P00000X	Emergency Medicine Physician	131461	AK
3	207P00000X	Emergency Medicine Physician	6515217-1205	UT

General Provider Information

NPI Number	:	1912075771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS C DILLON MD

Provider Business Mailing Address
First Line	:	5121 S COTTONWOOD ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-5701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5121 SOUTH COTTONWOOD STREET
Second Line	:
City	:	MURRY
State	:	UT
Zip	:	84157-0000
Country	:	US
Telephone Number	:	801-269-2500
Fax Number	:	801-269-2690

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	02/11/2025

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