Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 10385220-1205 | UT |
N | 2081S0010X | Sports Medicine | 10385220-1205 | UT |
N | 213ES0000X | Sports Medicine | 10385220-1205 | UT |
NPI | 1336128388 |
---|---|
Provider Name | Dr. Dallin L Demordaunt |
First Address | Layton, UT 84041-7060 |
Second Address | Layton, UT 84041-7060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100506883 | (05) | NV |
11505358 | CAQH (01) | NV |
3003101 | (05) | UT |
I34491 | (02) | NV |