Healthcare Provider Details

I. General information

NPI: 1316354780
Provider Name (Legal Business Name): UTAH HEMATOLOGY ONCOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5290 S 400 E
OGDEN UT
84405-7194
US

IV. Provider business mailing address

5290 S 400 E
OGDEN UT
84405-7194
US

V. Phone/Fax

Practice location:
  • Phone: 801-476-1777
  • Fax: 801-479-1479
Mailing address:
  • Phone: 801-476-1777
  • Fax: 801-479-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN PORTER
Title or Position: CEO
Credential:
Phone: 801-476-1777