Basic Information
Provider Information
NPI: 1720191216
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SOMMERS
FirstName: DANIEL
MiddleName: N
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: UNVERSITY OF UTAH
Address2: 30 N 1900 E #1A71
City: SALT LAKE CITY
State: UT
PostalCode: 841320001
CountryCode: US
TelephoneNumber: 8015817553
FaxNumber: 8015812414
Practice Location
Address1: 50 N MEDICAL DR
Address2:  
City: SALT LAKE CITY
State: UT
PostalCode: 841320001
CountryCode: US
TelephoneNumber: 8015812121
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/17/2006
LastUpdateDate: 09/30/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/30/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X6153773-1205UTY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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