Provider Demographics
NPI:1023031507
Name:HOUSEL, DARREN (MD)
Entity type:Individual
Prefix:
First Name:DARREN
Middle Name:
Last Name:HOUSEL
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 1:1525 EAST 6000 SOUTH
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405
Mailing Address - Country:US
Mailing Address - Phone:801-337-5800
Mailing Address - Fax:801-337-5809
Practice Address - Street 1:10350 E DREXEL RD STE 260
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-9405
Practice Address - Country:US
Practice Address - Phone:520-324-1727
Practice Address - Fax:520-324-1700
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5172031205207V00000X
OK17731207VG0400X
AZ61519207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806537000Medicaid
WY122387900Medicaid
UTD4670Medicaid
WY122387900Medicaid
ID806537000Medicaid