1639519390 NPI number — DANIEL JUSTIN FALK MD

Table of content: DANIEL JUSTIN FALK MD (NPI 1639519390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639519390 NPI number — DANIEL JUSTIN FALK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FALK
Provider First Name:
DANIEL
Provider Middle Name:
JUSTIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FALK
Provider Other First Name:
DANNY
Provider Other Middle Name:
JUSTIN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1639519390
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7368 S VISCAYNE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COTTONWOOD HEIGHTS
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84121-4928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-205-1085
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIVERSITY OF UTAH HOSPITAL 30 NORTH 1900
Provider Second Line Business Practice Location Address:
1C412
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84132-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-581-2401
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2013

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 10092679-1205 , 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: 10092679-1205 . This is a "UTAH MEDICAL LICENSURE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".