Basic Information
| Provider Information | |||||||||
| NPI: | 1336102979 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOUGHTON | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27128 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841270128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017796200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4401 HARRISON BLVD | ||||||||
| Address2: | |||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844033195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017796200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 11/26/2012 | ||||||||
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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 | 207R00000X | 25598 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 4811012-1205 | UT | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 4811012-1205 | UT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 48044 | CO | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 26011 | NE | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 25598 | AZ | Y | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 4811012-1205 | UT | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 422882 | 05 | AZ | MEDICAID |