Healthcare Provider Details

I. General information

NPI: 1326212234
Provider Name (Legal Business Name): R SCOTT HAUPT MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5292 COLLEGE DR #302
MURRAY UT
84123-2672
US

IV. Provider business mailing address

5292 COLLEGE DR #302
MURRAY UT
84123-2672
US

V. Phone/Fax

Practice location:
  • Phone: 801-293-8100
  • Fax:
Mailing address:
  • Phone: 801-293-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number2742511205
License Number StateUT

VIII. Authorized Official

Name: R SCOTT HAUPT
Title or Position: OWNER
Credential: MD
Phone: 801-293-8100