Provider Demographics
NPI:1154362747
Name:HILLAM, JOSEPH DALE (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DALE
Last Name:HILLAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5758 S HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6104
Mailing Address - Country:US
Mailing Address - Phone:385-204-2722
Mailing Address - Fax:801-713-1376
Practice Address - Street 1:990 MEDICAL DR
Practice Address - Street 2:SUITE U2
Practice Address - City:BRIGHAM
Practice Address - State:UT
Practice Address - Zip Code:84302-4713
Practice Address - Country:US
Practice Address - Phone:435-734-9439
Practice Address - Fax:435-723-0267
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2021-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT711529431205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD07762Medicare UPIN