Healthcare Provider Details

I. General information

NPI: 1659723567
Provider Name (Legal Business Name): LUKE W EDELMAYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 HARRISON BLVD
OGDEN UT
84403-4303
US

IV. Provider business mailing address

PO BOX 5546
DENVER CO
80217-5546
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-3075
  • Fax: 801-475-3076
Mailing address:
  • Phone: 801-475-3500
  • Fax: 801-475-3414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number14195356-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number14195356-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: