Healthcare Provider Details

I. General information

NPI: 1003710989
Provider Name (Legal Business Name): PERI HEALTH & HORMONES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 E PIONEER RD UNIT 105
DRAPER UT
84020-9343
US

IV. Provider business mailing address

2196 E FAIR WINNS LN
DRAPER UT
84020-2528
US

V. Phone/Fax

Practice location:
  • Phone: 480-686-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ROSCOE SCOTT NELSON
Title or Position: OWNER
Credential: MD
Phone: 480-686-5090