Healthcare Provider Details

I. General information

NPI: 1740483395
Provider Name (Legal Business Name): MOHAMMAD SHOARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N TRIUMPH BLVD STE 100
LEHI UT
84043-7186
US

IV. Provider business mailing address

3000 N TRIUMPH BLVD STE 100
LEHI UT
84043-7186
US

V. Phone/Fax

Practice location:
  • Phone: 385-345-3555
  • Fax: 385-345-3554
Mailing address:
  • Phone: 385-345-3555
  • Fax: 385-345-3554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number5761148-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: