Provider Demographics
NPI:1366404477
Name:SHEWELL, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SHEWELL
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 1:144 S 500 E
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1907
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1050 E SOUTH TEMPLE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1507
Practice Address - Country:US
Practice Address - Phone:801-350-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5924736-1205207PE0004X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD6492Medicaid
UTG12493Medicare UPIN
UT005567244Medicare ID - Type Unspecified5475 S 500 E, OGDEN
UT005568647Medicare ID - Type Unspecified1050 E SOUTH TEMPLE, SLC
UT005567152Medicare ID - Type Unspecified1600 ANTELOPE DR, LAYTON
UT005568363Medicare ID - Type Unspecified3460 PIONEER PKWY, WVC
UT005568457Medicare ID - Type Unspecified3580 W 9000 S, W JORDAN
UT005568564Medicare ID - Type Unspecified630 MEDICAL DR, BOUNTIFUL
UTD6492Medicaid