Individual
DR. ROSS BRIGHAM DASTRUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 E 3900 S, SALT LAKE CITY, UT 84124-1300
(801) 268-7975
(801) 270-3324
Mailing address
PO BOX 95970, SOUTH JORDAN, UT 84095-0970
(801) 352-9500
(801) 352-9502
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
7536235-1205
UT
207P00000X
Emergency Medicine Physician
PENDING
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902023773
—
UT
Enumeration date
04/20/2007
Last updated
10/01/2010
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