Provider Demographics
NPI:1578864476
Name:DYMOTT, CLEO E (MD)
Entity Type:Individual
Prefix:DR
First Name:CLEO
Middle Name:E
Last Name:DYMOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4926 QUAIL LN
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4436
Mailing Address - Country:US
Mailing Address - Phone:801-476-1514
Mailing Address - Fax:801-476-1514
Practice Address - Street 1:4926 QUAIL LN
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4436
Practice Address - Country:US
Practice Address - Phone:801-476-1514
Practice Address - Fax:801-476-1514
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT176793-12052085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology