Healthcare Provider Details

I. General information

NPI: 1356378095
Provider Name (Legal Business Name): SCOTT KENT THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 N ROBINS DR STE 205
LAYTON UT
84041-1181
US

IV. Provider business mailing address

2255 N ROBINS DR STE 205
LAYTON UT
84041-1181
US

V. Phone/Fax

Practice location:
  • Phone: 801-776-2220
  • Fax:
Mailing address:
  • Phone: 801-776-2220
  • Fax: 801-776-2534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number236470
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number6103240-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: