Provider Demographics
NPI:1497953384
Name:FRANCOM, DAVID S (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:FRANCOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5444 S. GREEN ST.
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5632
Mailing Address - Country:US
Mailing Address - Phone:801-262-2647
Mailing Address - Fax:801-262-3897
Practice Address - Street 1:5444 S. GREEN ST.
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-5632
Practice Address - Country:US
Practice Address - Phone:801-262-8120
Practice Address - Fax:801-262-5721
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7643696-12052085N0700X, 2085R0202X
IDM-115232085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1497953384OtherMOLINA HEALTHCARE
UT1497953384OtherTRIWEST/TRICARE
UT1497953384OtherEDUCATORS MUTUAL INS ASSN
UT1497953384Medicaid
UT155540OtherSTERLING HEALTH PLANS
UT1497953384OtherUUHP
UT10000000609001OtherBCBS OF UTAH
UT107085942101OtherSELECTHEALTH
UT121068OtherPEHP
UT1089853OtherDESERET MUTUAL BENEFIT ADMINISTRATORS
UTP00855367OtherRAILROAD MEDICARE
UT000069506Medicare PIN