Healthcare Provider Details

I. General information

NPI: 1821021718
Provider Name (Legal Business Name): JOHN D. WEIPERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S 1100 E
AMERICAN FORK UT
84003-2829
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-8788
  • Fax: 801-492-1285
Mailing address:
  • Phone: 801-756-8788
  • Fax: 801-492-1285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number891806241205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: