Provider Demographics
NPI:1508027541
Name:DAGAR, GAURAV (MD)
Entity Type:Individual
Prefix:DR
First Name:GAURAV
Middle Name:
Last Name:DAGAR
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:PO BOX 150627
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84415-0627
Mailing Address - Country:US
Mailing Address - Phone:385-492-4930
Mailing Address - Fax:385-492-4449
Practice Address - Street 1:5957 FASHION POINT DR
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-5180
Practice Address - Country:US
Practice Address - Phone:385-492-4930
Practice Address - Fax:385-492-4449
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125052392207R00000X
WI54311-20207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1508027541Medicaid
ILXOF844229646OtherBLUE CROSS, BLUE SHIELD