Provider Demographics
NPI:1568405397
Name:HAMP, DENNIS R (D O)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:R
Last Name:HAMP
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3895 W 7800 S
Mailing Address - Street 2:SUITE, 100
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5617
Mailing Address - Country:US
Mailing Address - Phone:801-280-7774
Mailing Address - Fax:801-748-2790
Practice Address - Street 1:3895 W 7800 S
Practice Address - Street 2:SUITE, 100
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5617
Practice Address - Country:US
Practice Address - Phone:801-280-7774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2757357-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD3449Medicaid
UT005508007Medicare ID - Type Unspecified
UTD3449Medicaid