Healthcare Provider Details

I. General information

NPI: 1598733586
Provider Name (Legal Business Name): SPENCER W GALT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 S. WOODROW STREET #102
MURRAY UT
84107
US

IV. Provider business mailing address

5444 GREEN ST
MURRAY UT
84123-5632
US

V. Phone/Fax

Practice location:
  • Phone: 801-713-1010
  • Fax: 810-713-0665
Mailing address:
  • Phone: 801-713-1010
  • Fax: 810-713-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD422280
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number29506-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: