Individual
DR. FREDERICK L. DATZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4615 FORTUNA WAY, SALT LAKE CITY, UT 84124-4764
(801) 272-0634
Mailing address
4615 FORTUNA WAY, SALT LAKE CITY, UT 84124-4764
(801) 272-0634
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
165352-1205
UT
Other
Enumeration date
05/06/2008
Last updated
05/06/2008
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