Individual
PETER P TAILLAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
UNIVERSITY OF UTAH DIVISION OF EMERGENCY MEDICINE, 30 NORTH 1900 EAST ROOM 1C026, SALT LAKE CITY, UT 84132-0001
(801) 581-2417
Mailing address
3439 CANYON COVE DR, HOLLADAY, UT 84121-6335
(801) 272-7606
(801) 272-5399
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
279025-1205
UT
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
279025-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D1205
—
UT
Enumeration date
04/04/2006
Last updated
07/16/2024
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