Individual
GEORGE W DELAVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
44 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84132-0001
(801) 584-8239
(801) 584-8588
Mailing address
2691 COMANCHE CIR, SALT LAKE CITY, UT 84108-2807
(801) 581-1258
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
160530-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
876000545
STATE OF UTAH DEPT. OF HEALTH
UT
05
—
999000021002
—
UT
Enumeration date
10/05/2006
Last updated
03/01/2012
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