Provider Demographics
NPI:1821336496
Name:DAHLE, KEVIN WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:WILLIAM
Last Name:DAHLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6272 S HIGHLAND DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2126
Mailing Address - Country:US
Mailing Address - Phone:801-871-6300
Mailing Address - Fax:801-871-6320
Practice Address - Street 1:6272 S HIGHLAND DR
Practice Address - Street 2:SUITE 202
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84121-2126
Practice Address - Country:US
Practice Address - Phone:801-871-6300
Practice Address - Fax:801-871-6320
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT9658525-1205207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology