Healthcare Provider Details

I. General information

NPI: 1053346734
Provider Name (Legal Business Name): MATTHEW GUNN WEEKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MATTHEW GUNN WEEKS M.D.

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 N WASHINGTON BLVD
NORTH OGDEN UT
84414-7233
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-786-7500
  • Fax:
Mailing address:
  • Phone: 801-786-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number52504331205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: