Provider Demographics
NPI:1003678178
Name:DIRECT PAY PEDIATRICS
Entity Type:Organization
Organization Name:DIRECT PAY PEDIATRICS
Other - Org Name:DIRECT CARE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:385-463-2757
Mailing Address - Street 1:1434 E 9400 S STE 100
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-2909
Mailing Address - Country:US
Mailing Address - Phone:385-463-2757
Mailing Address - Fax:385-488-0693
Practice Address - Street 1:1434 E 9400 S STE 100
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-2909
Practice Address - Country:US
Practice Address - Phone:385-463-2757
Practice Address - Fax:385-488-0693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty