Provider Demographics
NPI:1598872988
Name:DURCAN, SIMON P (MD)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:P
Last Name:DURCAN
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 1:174 S 1200 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1643
Mailing Address - Country:US
Mailing Address - Phone:801-891-4136
Mailing Address - Fax:
Practice Address - Street 1:100 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-993-9551
Practice Address - Fax:801-733-5872
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT376600-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT741279OtherDESERET MUTUAL
UTTPRA08188OtherMOLINA
MT0153204Medicaid
UT74312OtherPEHP
UTQM0000070013OtherALTIUS
UT291OtherHEALTHY U
UT37660012001001OtherBCBS
UT107011688102OtherIHC
UT741279OtherIHC