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NPI Code Detail

MEDICARE: DR. WILLIAM PIDWELL

MEDICARE: DR. WILLIAM PIDWELL
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
1173000000XLegal Medicine5755327-1205UT
2207Q00000XFamily Medicine Physician5755327-1205UT

General Provider Information

NPI Number : 1548208028
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIAM PIDWELL
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number : 801-491-6482
Fax Number :
Provider Business Practice Location Address
First Line : 750 ROUND VALLEY DR.
Second Line : SUITE 201
City : PARK CITY
State : UT
Zip : 84060-5127
Country : US
Telephone Number : 435-649-7640
Fax Number : 435-649-1365
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2006
Last Update Date : 08/31/2012

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Directions to “ DR. WILLIAM PIDWELL ” Practice Location

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