MEDICARE: DR. CHARLES DARRELL KATZ 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	174400000X	Specialist	H0511	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1922091230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES DARRELL KATZ M.D.

Provider Business Mailing Address
First Line	:	9450 S 1300 E
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84094-5555
Country	:	US
Telephone Number	:	801-501-6200
Fax Number	:	801-501-6210

Provider Business Practice Location Address
First Line	:	9450 S 1300 E
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84094-5555
Country	:	US
Telephone Number	:	801-501-6200
Fax Number	:	801-501-6210

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	01/21/2016

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