Provider Demographics
NPI:1871524421
Name:BARKDULL, THAD JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:THAD
Middle Name:JOSEPH
Last Name:BARKDULL
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 1:830 N 2000 W
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-4047
Mailing Address - Country:US
Mailing Address - Phone:801-756-3511
Mailing Address - Fax:801-443-1164
Practice Address - Street 1:830 N 2000 W
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-4047
Practice Address - Country:US
Practice Address - Phone:801-756-3511
Practice Address - Fax:801-443-1164
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT53652411205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1871524421OtherALTIUS
UT107025832102OtherSELECT HEALTH
UT1106193OtherDESERET HEALTHCARE TRUST
UT1871524421Medicaid
UTP01065419OtherRAILROAD MEDICARE
UT128704OtherPEHP
UT1871524421OtherTRICARE
UT107025832102OtherSELECT HEALTH