Individual
DARYL RAY EZIDORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 SOUTH 344 EAST, SALT LAKE CITY, UT 84101
(801) 322-3222
Mailing address
5636 S 3650 W, TAYLORSVILLE, UT 84129-3661
(801) 755-5415
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/30/2015
Last updated
05/11/2023
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