1386714459 NPI number — TODD THOMAS DOXEY D.C, M.P.H.

Table of content: CHELSEY A MCKINNON M.D. (NPI 1679925424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386714459 NPI number — TODD THOMAS DOXEY D.C, M.P.H.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOXEY
Provider First Name:
TODD
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C, M.P.H.
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:
1386714459
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
464 29TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OGDEN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84401-4243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-394-9450
Provider Business Mailing Address Fax Number:
801-866-0033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4013 PACIFIC AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERDALE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84405-1511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-394-9450
Provider Business Practice Location Address Fax Number:
801-866-0033
Provider Enumeration Date:
11/08/2006

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: 111N00000X , with the licence number:  345031-1202 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: QM0000026401 . This is a "ALTIUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 870395551DO4 . This is a "EDUCATORS MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 48453 . This is a "PUBLIC EMPLY HEALTH PLAN" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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