Provider Demographics
NPI:1811123169
Name:LAW, DENNIS PORTER (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:PORTER
Last Name:LAW
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 1:1950 E FOREST CREEK LN
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5049
Mailing Address - Country:US
Mailing Address - Phone:801-845-3100
Mailing Address - Fax:801-274-3447
Practice Address - Street 1:375 E 5350 S
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6934
Practice Address - Country:US
Practice Address - Phone:801-845-3100
Practice Address - Fax:801-274-3447
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7932637-1205207R00000X, 208M00000X, 207RH0002X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000076199Medicare PIN