Healthcare Provider Details

I. General information

NPI: 1417338161
Provider Name (Legal Business Name): ADAM BOWEN WOOD D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 E 90 N STE 101
AMERICAN FORK UT
84003-2954
US

IV. Provider business mailing address

1248 E 90 N STE 101
AMERICAN FORK UT
84003-2954
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-4200
  • Fax: 801-756-8252
Mailing address:
  • Phone: 801-756-4200
  • Fax: 801-756-8252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number10891203-0501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: