Basic Information
| Provider Information | |||||||||
| NPI: | 1962509612 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TIMPSON | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1954 FORT UNION BLVD STE 114 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841216899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005945736 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1954 FORT UNION BLVD STE 114 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841216899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005945736 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2006 | ||||||||
| LastUpdateDate: | 09/24/2007 | ||||||||
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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 | 207L00000X | 165168-1205 | UT | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | QM0000054865 | 01 | UT | ALTIUS | OTHER | 614 | 01 | UT | HEALTHY U | OTHER | 66106 | 01 | UT | PEHP | OTHER | 107006239104 | 01 | UT | IHC | OTHER | 36121 | 01 | UT | DESERET MUTUAL | OTHER | TPRA06833 | 01 | UT | MOLINA | OTHER |