Healthcare Provider Details

I. General information

NPI: 1326425497
Provider Name (Legal Business Name): HYATT WHITMAN REED PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5131 S COTTONWOOD ST # L-2
MURRAY UT
84107-5701
US

IV. Provider business mailing address

1121 E 3900 S SUITE C230
SALT LAKE CITY UT
84124-1214
US

V. Phone/Fax

Practice location:
  • Phone: 801-263-3416
  • Fax: 801-263-3428
Mailing address:
  • Phone: 801-262-9494
  • Fax: 866-415-6807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9338755-1206
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9338755-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: