MEDICARE: PARK CITY PODIATRY LLC

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	213E00000X	Podiatrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437116266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK CITY PODIATRY LLC

Provider Business Mailing Address
First Line	:	PO BOX 404
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-0404
Country	:	US
Telephone Number	:	801-619-2168
Fax Number	:	877-428-7520

Provider Business Practice Location Address
First Line	:	1220 E 3900 S STE 4D
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1383
Country	:	US
Telephone Number	:	801-269-9939
Fax Number	:	801-269-9949

Authorized Official
Title or Position	:	OWNER
Name	:	FREDERIC ZACHARY ODDONE
Credential	:	DPM
Telephone Number	:	801-269-9939

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	03/12/2026

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Directions to “PARK CITY PODIATRY LLC ” Practice Location

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