Provider Demographics
NPI:1912965344
Name:DAHL, CHARLES F (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:F
Last Name:DAHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 741729
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1729
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 W 800 N STE 444
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-6305
Practice Address - Country:US
Practice Address - Phone:801-714-6412
Practice Address - Fax:801-714-6412
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2025-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1597521205207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT060011266OtherPALMETO GBA
UT107006246101OtherIHC HEALTHPLANS
UT8974OtherPEHP
UTQM0000001553OtherALTIUS
UT36042OtherDMBA
UT870281028DA1OtherEMIA
UTD07410Medicare UPIN