Individual
MR. DEVON E. DAHLKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
630 E 1400 N STE 150, LOGAN, UT 84341-2549
(435) 915-4465
(435) 514-4556
Mailing address
740 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5285
(208) 542-9111
(208) 542-9114
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
5703274-1206
UT
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
$$$$$$$$$
CHAMPUS
UT
05
—
1598866691
—
UT
Enumeration date
09/25/2006
Last updated
12/01/2020
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