Healthcare Provider Details

I. General information

NPI: 1730997610
Provider Name (Legal Business Name): BIOBALANCE MEDICAL PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

392 E 12300 S STE A
DRAPER UT
84020-8043
US

IV. Provider business mailing address

392 E 12300 S STE A
DRAPER UT
84020-8043
US

V. Phone/Fax

Practice location:
  • Phone: 801-278-9008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: REED DAVIS
Title or Position: PRESIDENT
Credential:
Phone: 801-367-8884