Individual
DR. DAVID MORTIN GONTRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4745 S 3200 W, SALT LAKE CITY, UT 84118-2822
(801) 964-6214
Mailing address
1082 LAKE ST, SALT LAKE CITY, UT 84105-1261
(801) 537-1642
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
350320-1205
UT
Other
Enumeration date
12/21/2005
Last updated
11/07/2011
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