Dedrickson, David Ray

Dedrickson, David Ray is an individual health care provider with primary practice located at 1433 N 1075 W Ste 104, Farmington UT 84025-2746. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Dedrickson, David Ray can be contacted via phone (801) 298-1300.

Contact Information

Primary practice address
1433 N 1075 W Ste 104 Farmington UT 84025-2746
Phone: (801) 298-1300
Fax: (801) 296-6199
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 184965-1205 Utah

Profile Details

NPI number 1144222779
LBN Legal business name Dedrickson, David Ray
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 12th, 2005
Last updated Feb 19th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144222779 NPPES
Utah MEDICAID 10536
Utah MEDICAID 120727000
Utah MEDICAID 922890
Utah Other P00199660
Utah Other P00651526
Utah MEDICAID 100505581
Utah MEDICAID 807116200

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