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

Table of content: TODD THOMAS DOXEY D.C, M.P.H. (NPI 1386714459)

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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