Provider Demographics
NPI:1962509612
Name:TIMPSON, DAVID G (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:TIMPSON
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 1:1954 FORT UNION BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6899
Mailing Address - Country:US
Mailing Address - Phone:800-594-5736
Mailing Address - Fax:
Practice Address - Street 1:1954 FORT UNION BLVD STE 114
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-6899
Practice Address - Country:US
Practice Address - Phone:800-594-5736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT165168-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQM0000054865OtherALTIUS
UT614OtherHEALTHY U
UT66106OtherPEHP
UT107006239104OtherIHC
UT36121OtherDESERET MUTUAL
UTTPRA06833OtherMOLINA
UTTPRA06833OtherMOLINA