Basic Information
| Provider Information | |||||||||
| NPI: | 1679565758 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BYCK | ||||||||
| FirstName: | DANN | ||||||||
| MiddleName: | CONRAD | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 150087 | ||||||||
| Address2: | |||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844150087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019178000 | ||||||||
| FaxNumber: | 8019178001 | ||||||||
| Practice Location | |||||||||
| Address1: | 5782 ADAMS AVENUE PARKWAY | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON TERRACE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019178000 | ||||||||
| FaxNumber: | 8019178001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2005 | ||||||||
| LastUpdateDate: | 08/30/2010 | ||||||||
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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 | 207X00000X | 51866291205 | UT | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 870580455 | 01 | AETNA | OTHER | 870680455 | 01 | BENEFIT PLANNERS | OTHER | 51866291200001 | 01 | BC OF WYO | OTHER | 870680455BYC | 01 | ED IHC CARE PLUS | OTHER | 870680455 | 01 | AM POSTAL WORKERS UNION | OTHER | 870680455 | 01 | BENEFIT PLAN ADMIN | OTHER | 870680455 | 01 | CBSA CORPORATE | OTHER | 870680455 | 01 | EBMS EMPLOYEE BENEFIT | OTHER | OM0000058953 | 01 | ALTUS | OTHER | 51866291200001 | 01 | BCBS | OTHER | 51866291200001 | 01 | BCBS OF OTHER STATE | OTHER | 870680455 | 01 | CIGNA | OTHER | D4621 | 05 | UT | MEDICAID | 4360680001 | 01 | CIGNA DMERC | OTHER | 659750 | 01 | DESERT MUTUAL | OTHER | 870680455 | 01 | I159 ACORDIA NATIONAL | OTHER | 870680455 | 01 | CCN | OTHER |