Healthcare Provider Details

I. General information

NPI: 1689369159
Provider Name (Legal Business Name): SAMUEL S MAY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 HARRISON BLVD
OGDEN UT
84403-3195
US

IV. Provider business mailing address

PO BOX 719
BRIGHAM CITY UT
84302-0719
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-3850
  • Fax:
Mailing address:
  • Phone: 801-505-0821
  • Fax: 801-505-0803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10507415-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: