MEDICARE: WILLIAM TUPPER COULDWELL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	5022518-1205	UT

General Provider Information

NPI Number	:	1265522858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM TUPPER COULDWELL MD

Provider Business Mailing Address
First Line	:	175 N MEDICAL DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-1103
Country	:	US
Telephone Number	:	801-585-6065
Fax Number	:	801-585-6087

Provider Business Practice Location Address
First Line	:	175 N MEDICAL DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-1103
Country	:	US
Telephone Number	:	801-585-6065
Fax Number	:	801-585-6087

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	11/07/2025

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