DR. DAVID MORTIN GONTRUM (NPI# 1922084813) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922084813 |
| Entity Type | Individual |
| Full Name | DR. DAVID MORTIN GONTRUM |
| Credential | M.D. |
| Practice Address |
4745 S 3200 W Salt Lake City UT 84118-2822 |
| Mailing Address |
1082 Lake St Salt Lake City UT 84105-1261 |
| Practice Telephone | 8019646214 |
| Mailing Telephone | 8015371642 |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2011-11-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 350320-1205 | UT | Allopathic & Osteopathic Physicians |
| Street Address |
4745 S 3200 W |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84118-2822 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174962963 | Maria Dalia Garza | Counselor | 4745 S 3200 W, Salt Lake City, UT 84129-2822 | 2013-06-14 |
| 1215238530 | Susanna Benavidez Chapman | Physician Assistant | 4745 S 3200 W, Taylorsville, Salt Lake City, UT 84118-2822 | 2010-11-03 |
| 1548471147 | Linda Stearns | Registered Nurse | 4745 S 3200 W, Salt Lake City, UT 84118-2822 | 2007-05-24 |
| 1770600918 | Thomas Carlyle Whittaker | Family Medicine | 4745 S 3200 W, Salt Lake City, UT 84118-2822 | 2007-03-23 |
| 1801992953 | Community Health Centers Inc. | Obstetrics & Gynecology | 4745 S 3200 W, Salt Lake City, UT 84118-2822 | 2006-09-16 |
| 1356446215 | Martha P Mandujano | Physician Assistant | 4745 S 3200 W, Salt Lake City, UT 84118-2822 | 2006-09-14 |
| 1902901838 | Phung Kim Do | Physician Assistant | 4745 S 3200 W, Salt Lake City, UT 84118-2822 | 2006-09-14 |
| 1316923113 | Keith Owen Horwood | Family Medicine | 4745 S 3200 W, Salt Lake City, UT 84118-2822 | 2005-12-22 |
| 1265419022 | Kathy Jane Pedersen | Family Medicine | 4745 S 3200 W, Salt Lake City, UT 84118-2822 | 2005-12-22 |
| 1902883721 | Paula Anne Guerra | Family Medicine | 4745 S 3200 W, Salt Lake City, UT 84118-2822 | 2005-12-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225527500 | Hoan K Doan | Case Manager/Care Coordinator | 3809 West 6200 South, Kearns, UT 84118 | 2018-05-02 |
| 1750664785 | Giao L Tran | Pharmacist | 5586 W 6200 S, Slc, UT 84118 | 2011-09-26 |
| 1982913406 | Brent James Seely | Counselor | 5934 S 8400 W, Kearns, UT 84118 | 2010-10-01 |
| 1558593830 | Easterseals-goodwill Northern Rocky Mountain, Inc. | Early Intervention Provider Agency | 5242 South 4820 West, Att Janet Wade, Kearns, UT 84118 | 2009-08-20 |
| 1063643120 | Phung Matthews | Pharmacist | 1837 West 4700 South, Taylorsville, UT 84118 | 2009-08-06 |
| 1689824963 | Mary Candace Christensen | Social Worker | 3703 West 6200 South, Valley Mental Health Artec - Therapeutic Foster Care, Bennion, UT 84118 | 2008-09-24 |
| 1164695128 | Life's Endeavour | Chiropractor | 2494 West Sharron Drive, Taylorsville, UT 84118 | 2008-04-10 |
| 1750585485 | Wendy Kay Cotting | Pediatrics | Taylorsville Kidscare, 3845 W. 4700 S., Taylorsville, UT 84118 | 2007-06-14 |
| 1720102841 | Wendy Lee Bingham | Physical Therapist | 3845 W. 4700 S., Ihc Taylorsville Health Center, Taylorsville, UT 84118 | 2007-03-16 |
| 1417028952 | Terry Milo Hansen | Optometrist | 2828 West 4700 South, Suite D, West Valley City, UT 84118 | 2006-11-13 |
| Find all providers in zip 84118 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356957468 | Aubrie Dawn Tilley | Family Medicine | 1741 E Imperial Park Ln, Salt Lake City, UT 84106-3379 | 2020-09-23 |
| 1457969834 | Sandra Lee Porter | Family Medicine | 3979 S Jester Dr, Salt Lake City, UT 84123-1227 | 2020-07-21 |
| 1265057673 | Onsite Care Clinics | Family Medicine | 230 S 500 E Ste 510, Salt Lake City, UT 84102-2028 | 2020-06-11 |
| 1467097071 | Centric Physicians Intermountain Region, Pllc | Family Medicine | 7101 N Mesa Street #365, Salt Lake City, UT 84101-1603 | 2019-11-07 |
| 1760036024 | Mindy Marie Wade | Family Medicine | 1950 E Fort Union Blvd, Salt Lake City, UT 84121-6894 | 2019-07-25 |
| 1841854338 | Tandy Muse | Family Medicine | 4460 S Highland Dr Ste 400, Salt Lake City, UT 84124-3565 | 2019-04-30 |
| 1821561408 | Terra Bowden | Family Medicine | 450 S 900 E Ste 175, Salt Lake City, UT 84102-2981 | 2019-01-07 |
| 1801379193 | Country Corner Family Medicine | Family Medicine | 5460 W Clernates Dr, Salt Lake City, UT 84118-8526 | 2018-09-12 |
| 1396259008 | Futura Medical Clinic | Family Medicine | 1407 W North Temple Ste 120, Salt Lake City, UT 84116-3187 | 2017-11-17 |
| 1255858734 | Fjm Basecamp | Family Medicine | 185 S State St Ste 208, Salt Lake City, UT 84111-1558 | 2017-08-25 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84118 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.