Individual
DR. DALLIN L DEMORDAUNT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2132 N 1700 W STE 230, LAYTON, UT 84041-7060
(801) 773-3900
(801) 773-3902
Mailing address
2132 N 1700 W STE 230, LAYTON, UT 84041-7060
(801) 773-3900
(801) 773-3902
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
10385220-1205
UT
208100000X
Physical Medicine & Rehabilitation Physician
Primary
10385220-1205
UT
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
10385220-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100506883
—
NV
01
—
11505358
CAQH
NV
05
—
3003101
—
UT
Enumeration date
01/10/2006
Last updated
03/17/2018
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