Provider Demographics
NPI:1992707657
Name:DALL, JOEL T (MD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:T
Last Name:DALL
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 1:280 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6236
Mailing Address - Country:US
Mailing Address - Phone:801-505-0821
Mailing Address - Fax:801-505-0803
Practice Address - Street 1:1160 E 3900 S STE 4050
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1264
Practice Address - Country:US
Practice Address - Phone:801-262-8486
Practice Address - Fax:801-284-8699
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2023-09-14
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
UT275517-1205208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD0651Medicaid
UTD0651Medicaid
UT005590504Medicare PIN