Provider Demographics
NPI:1407021702
Name:KOFFORD, NATHANIEL DAVID (MD, MSPH)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:DAVID
Last Name:KOFFORD
Suffix:
Gender:M
Credentials:MD, MSPH
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3340 N CENTER ST
Mailing Address - Street 2:#800
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:900 ROUND VALLEY DRIVE
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7532
Practice Address - Country:US
Practice Address - Phone:435-658-7000
Practice Address - Fax:801-990-1912
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0011896207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology