Healthcare Provider Details

I. General information

NPI: 1427074582
Provider Name (Legal Business Name): EDWARD JOSEPH EYRING II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 E 4500 S SUITE 200
MURRAY UT
84107-3906
US

IV. Provider business mailing address

348 E 4500 S SUITE 200
MURRAY UT
84107-3906
US

V. Phone/Fax

Practice location:
  • Phone: 801-265-3978
  • Fax: 801-265-3988
Mailing address:
  • Phone: 801-265-3978
  • Fax: 801-265-3988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number313827-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: