Individual
DR. DEREK DAVID MUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4460 HIGHLAND DR STE 400, SALT LAKE CITY, UT 84124-3565
(801) 272-4111
(801) 272-5989
Mailing address
4460 HIGHLAND DR STE 400, SALT LAKE CITY, UT 84124-3565
(801) 272-4111
(801) 272-5989
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
181302-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000065111
MEDICARE PTAN
UT
Enumeration date
11/07/2006
Last updated
06/29/2011
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