Basic Information
| Provider Information | |||||||||
| NPI: | 1184807208 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRODSHAM | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | EUGENE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4624 S HOLLADAY BLVD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841177054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018102999 | ||||||||
| FaxNumber: | 8014070747 | ||||||||
| Practice Location | |||||||||
| Address1: | 4624 S HOLLADAY BLVD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841177054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018102999 | ||||||||
| FaxNumber: | 8014070747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2007 | ||||||||
| LastUpdateDate: | 04/11/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | 309974-1205 | UT | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0202X | 309974-1205 | UT | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1184807208 | 01 | UT | EDUCATORS MUTUAL | OTHER | 1104759 | 01 | UT | DMBA | OTHER | 107100028101 | 01 | UT | SELECTHEALTH | OTHER | P00953836 | 01 | UT | RAILROAD MEDICARE | OTHER | 1184807208 | 05 | UT | MEDICAID | 10000002852001 | 01 | UT | BCBSU | OTHER | 129993 | 01 | UT | PEHP | OTHER | 862620 | 01 | UT | STERLING HEALTH PLANS | OTHER |