Healthcare Provider Details

I. General information

NPI: 1982696076
Provider Name (Legal Business Name): CARL ANTHONY MATTSSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 HARRISON BLVD STE 2600
OGDEN UT
84403-3271
US

IV. Provider business mailing address

4403 HARRISON BLVD STE 2600
OGDEN UT
84403-3271
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-2600
  • Fax: 801-387-2625
Mailing address:
  • Phone: 801-387-2600
  • Fax: 801-387-2625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number155171-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: