Healthcare Provider Details

I. General information

NPI: 1972503696
Provider Name (Legal Business Name): UTAH DIGESTIVE HEALTH INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date: 08/02/2005
Reactivation Date: 08/24/2007

III. Provider practice location address

6028 S RIDGELINE DR #201
OGDEN UT
84405-6914
US

IV. Provider business mailing address

6028 S RIDGELINE DR #201
OGDEN UT
84405-6914
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-5400
  • Fax: 801-475-8614
Mailing address:
  • Phone: 801-475-5400
  • Fax: 801-475-8614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN E LOWE
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 801-475-5400