Provider Demographics
NPI:1730119199
Name:TUFAU, GUY E (MD)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:E
Last Name:TUFAU
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 1:675 E 2100 S
Mailing Address - Street 2:SUITE 390
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-1887
Mailing Address - Country:US
Mailing Address - Phone:800-366-1884
Mailing Address - Fax:866-360-6021
Practice Address - Street 1:675 E 2100 S
Practice Address - Street 2:SUITE 390
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1887
Practice Address - Country:US
Practice Address - Phone:800-366-1884
Practice Address - Fax:866-360-6021
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA023536002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F39063Medicare UPIN