Individual
SHANE CARLSON DANGERFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132
(801) 581-2205
Mailing address
PO BOX 413021, SALT LAKE CITY, UT 84141-3021
(801) 213-3900
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
9003692-1205
UT
2081P0010X
Pediatric Rehabilitation Medicine Physician
4301094767
MI
2081P0010X
Pediatric Rehabilitation Medicine Physician
Primary
9003692-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457685919
—
UT
Enumeration date
09/30/2009
Last updated
12/03/2021
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