Provider Demographics
NPI:1588623896
Name:POYNOR, TOM CHRISTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:CHRISTIAN
Last Name:POYNOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:T.
Other - Middle Name:CHRISTIAN
Other - Last Name:POYNOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-576-0176
Mailing Address - Fax:801-442-0643
Practice Address - Street 1:9493 S 700 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3459
Practice Address - Country:US
Practice Address - Phone:801-576-0176
Practice Address - Fax:801-523-2657
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22971207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200030020AMedicaid
OK245528102Medicare ID - Type Unspecified
OKH14240Medicare UPIN