Individual
TALA'AT AL-SHUQAIRAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
555 W SR 164, SALEM, UT 84653-1666
(801) 465-4813
(801) 812-5433
Mailing address
1055 N 500 W, ATTN: CREDENTIALING, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
60083151205
UT
207RP1001X
Pulmonary Disease Physician
Primary
60083151205
UT
207RS0012X
Sleep Medicine (Internal Medicine) Physician
60083151205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000059100
MEDICARE
UT
05
—
870281028000
—
UT
Enumeration date
05/10/2006
Last updated
11/27/2023
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