Healthcare Provider Details

I. General information

NPI: 1346589819
Provider Name (Legal Business Name): JOHN G. SKEDROS, M.D. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 S WOODROW ST STE 200
MURRAY UT
84107-5844
US

IV. Provider business mailing address

5323 S WOODROW ST STE 200
MURRAY UT
84107-5844
US

V. Phone/Fax

Practice location:
  • Phone: 801-747-1020
  • Fax: 801-747-1023
Mailing address:
  • Phone: 801-747-1020
  • Fax: 801-747-1023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number350848-1205
License Number StateUT

VIII. Authorized Official

Name: JOHN G SKEDROS
Title or Position: PRESIDENT
Credential: MD
Phone: 801-747-1020