NPI 1205852613 · live from the CMS NPI Registry
David M Fantle, MD
Psychiatry & Neurology, Neurology in Salt Lake City, UT. National Provider Identifier 1205852613, active.
NPI record
| NPI | 1205852613 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Psychiatry & Neurology, Neurology 2084N0400X |
| Practice location | 400 C St, Salt Lake City, UT 84143 |
| Practice phone | 801-408-8305 |
| Mailing address | Po Box 27128, Salt Lake City, UT 84127 |
| Enumerated | July 15, 2006 |
| Last updated | March 18, 2008 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychiatry & Neurology, Neurology primary | 2084N0400X | 3344141205 (UT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.