1760573976 NPI number — DR. DAHVYN BISHOP OSHER PHD

Table of content: DR. DAHVYN BISHOP OSHER PHD (NPI 1760573976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760573976 NPI number — DR. DAHVYN BISHOP OSHER PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSHER
Provider First Name:
DAHVYN
Provider Middle Name:
BISHOP
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760573976
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
718 GRAND OAKS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAYSVILLE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84037-6763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-309-0629
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1725 EAST 1450 SOUTH
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
CLEARFIED
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-773-0535
Provider Business Practice Location Address Fax Number:
801-773-0536
Provider Enumeration Date:
09/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)