Healthcare Provider Details

I. General information

NPI: 1437022308
Provider Name (Legal Business Name): SUMMIT MOHS DERMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5089 WEST 11800 SOUTH SUITE 202
HERRIMAN UT
84096
US

IV. Provider business mailing address

1500 W 4800 S
TAYLORSVILLE UT
84123-4210
US

V. Phone/Fax

Practice location:
  • Phone: 801-980-2546
  • Fax:
Mailing address:
  • Phone: 801-980-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID COWART
Title or Position: OWNER
Credential: MD
Phone: 801-980-2546