| NPI | 1750725735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER GUYMON Credentialing Specialist 801-769-2571 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine |
| 207N00000X Dermatology | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2024-06-26 |