Individual
DR. DAVID RAY DEDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1433 N 1075 W, STE 104, FARMINGTON, UT 84025-2746
(801) 298-1300
(801) 296-6199
Mailing address
PO BOX 25488, SALT LAKE CITY, UT 84125-0488
(800) 475-3698
(801) 296-6199
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
184965-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100505581
—
NV
05
—
10536
—
UT
05
—
120727000
—
WY
05
—
807116200
—
ID
05
—
922890
—
AZ
01
—
P00199660
RR MEDICARE
UT
01
—
P00651526
RR MEDICARE
UT
Enumeration date
08/12/2005
Last updated
02/19/2019
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