Individual
DAVID GORDON AFFLECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1160 E 3900 S, SUITE 3500, SALT LAKE CITY, UT 84124-1202
(801) 743-4750
(801) 743-4765
Mailing address
PO BOX 281490, ATLANTA, GA 30384-1490
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
346120-1206
UT
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
3461201205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
134332141
TAX IDENTIFICATION
UT
05
—
D5506
—
UT
01
—
P00424176
RR MEDICARE
UT
Enumeration date
08/17/2005
Last updated
01/26/2022
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