Healthcare Provider Details

I. General information

NPI: 1063715589
Provider Name (Legal Business Name): HESPERIDES HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5986 S TOLCATE WOODS LN
HOLLADAY UT
84121-1536
US

IV. Provider business mailing address

5986 S TOLCATE WOODS LN
HOLLADAY UT
84121-1536
US

V. Phone/Fax

Practice location:
  • Phone: 801-682-6817
  • Fax: 801-206-3616
Mailing address:
  • Phone: 801-682-6817
  • Fax: 801-206-3616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS ROLAND SMITH
Title or Position: CEO
Credential: M.D.
Phone: 801-682-6817