DAVID M FANTLE (NPI# 1205852613) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205852613 |
| Entity Type | Individual |
| Full Name | DAVID M FANTLE |
| Credential | MD |
| Practice Address |
400 C St Salt Lake City UT 84143-1005 |
| Mailing Address |
Po Box 27128 Salt Lake City UT 84127-0128 |
| Practice Telephone | 8014088305 |
| Mailing Telephone | 8014088305 |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2008-03-18 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
3344141205 | UT | Allopathic & Osteopathic Physicians |
| Street Address |
400 C ST |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84143-1005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700802246 | Michael J Lahey | Internal Medicine | 400 C St, Salt Lake City, UT 84143-1005 | 2006-07-15 |
| 1306908264 | Christina A Lloyd | Nurse Practitioner | 400 C St, Salt Lake City, UT 84143-1005 | 2006-12-15 |
| 1659441780 | Michael Francis Coudreaut | Psychiatry & Neurology | 400 C St, Salt Lake City, UT 84143-1005 | 2006-11-08 |
| 1104996222 | David K Ryser | Psychiatry & Neurology | 400 C St, Salt Lake City, UT 84143-1005 | 2006-11-08 |
| 1811092216 | Craig R Jensen | Anesthesiology | 400 C St, Salt Lake City, UT 84143-1005 | 2006-09-13 |
| 1730281478 | Theodore J Wander | Psychiatry & Neurology | 400 C St, Salt Lake City, UT 84143-1005 | 2006-09-02 |
| 1205938958 | Bradley J Morris | Physician Assistant | 400 C St, Salt Lake City, UT 84143-1005 | 2006-09-02 |
| 1295837938 | Jess A Cone | Social Worker | 400 C St, Salt Lake City, UT 84143-1005 | 2006-09-02 |
| 1790887446 | Frank O Thomas | Internal Medicine | 400 C St, Salt Lake City, UT 84143-1005 | 2006-09-02 |
| 1639271398 | Polly P Bailey | Nurse Practitioner | 400 C St, Salt Lake City, UT 84143-1005 | 2006-09-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053725572 | Robert Thomas Nuttall | Respiratory Therapist, Registered | 8th Ave. and C Street, Salt Lake City, UT 84143 | 2014-06-12 |
| 1346447331 | Intermountain Healthcare | General Acute Care Hospital | 8th Avenue and 'c' Street, Salt Lake City, UT 84143 | 2007-07-02 |
| 1629142898 | Robert L Mazzola | Internal Medicine | 8th & C Street, Intermountain Sleep Disorders Center - Lds Hospital, Salt Lake City, UT 84143 | 2006-11-20 |
| 1053407726 | Tom V Cloward | Internal Medicine | 400 D Street Ste 206, Salt Lake City, UT 84143 | 2006-10-04 |
| 1396838926 | Sharon Briggs Schneider | Pharmacist | 8th Ave and C Street, Salt Lake City, UT 84143 | 2006-10-02 |
| 1700818911 | Rebecca Bailey | Psychologist | 4n, 8th Ave C Street, Salt Lake City, UT 84143 | 2006-07-07 |
| 1851348924 | Gayle White | Nurse Practitioner | 8th Ave C Street, Lds Hospital Wound Care Service, Salt Lake City, UT 84143 | 2006-05-27 |
| 1669459301 | Steven Eugene Nickman | Physician Assistant | 8th Avenue & C Street, Lds Hospital E8/ibmt Program, Salt Lake City, UT 84143 | 2005-12-23 |
| 1912454448 | Todd J Seamons | Pharmacist | 8th Ave & C St, Outpatient Pharmacy, Salt Lake City, UT 84143 | 2016-09-01 |
| 1235568130 | Intermountain Healthcare | General Acute Care Hospital | 8th Avenue and C St, Lds Hospital, Salt Lake City, UT 84143 | 2013-11-01 |
| Find all providers in zip 84143 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720648744 | Carepoint Health, LLC | Psychiatry & Neurology | St. Mark's Hospital, 1200 E 3900 S, Salt Lake City, UT 84124-1300 | 2019-06-20 |
| 1801273743 | Michael Cline | Psychiatry & Neurology | 825 E 1700 S, Salt Lake City, UT 84105-3225 | 2015-04-29 |
| 1619219847 | Mark Waheed | Psychiatry & Neurology | The University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132-0001 | 2013-03-26 |
| 1568707586 | Kyle Mahoney | Psychiatry & Neurology | 175 N Medical Drive E 3rd Floor, Salt Lake City, UT 84132 | 2012-12-03 |
| 1699076224 | Angela Yvonne Peters | Psychiatry & Neurology | University of Utah Dept of Neurology, 175 N Medical Drive East, Salt Lake City, UT 84132-0001 | 2010-11-12 |
| 1568697514 | Safdar Abbas Ansari | Psychiatry & Neurology | 175 N Medical Dr E Rm 3130, University of Utah, Clinical Neuroscience Center, Salt Lake City, UT 84132-0001 | 2009-05-20 |
| 1427235001 | Kevin Alan Walker | Psychiatry & Neurology | 440 D St Ste 200, Salt Lake City, UT 84103-2827 | 2008-01-26 |
| 1144376831 | Pegah Afra | Psychiatry & Neurology | Department of Neurology 175 North Medical, Salt Lake City, UT 84132-0001 | 2007-01-26 |
| 1801968359 | David Scott Peterson | Psychiatry & Neurology | 1345 East 3900 South Ste 208, Salt Lake City, UT 84124-4416 | 2006-11-13 |
| 1831271352 | Sharon Mae Weinstein | Psychiatry & Neurology | Veterans Affairs Slchcs, 500 Foothill Blvd - 112, Salt Lake City, UT 84148-0001 | 2006-10-20 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84143 |
Please comment or provide details below to improve the information on DAVID M FANTLE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.