Healthcare Provider Details

I. General information

NPI: 1730832163
Provider Name (Legal Business Name): NEUREGEN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 01/26/2022
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 N 400 W STE B7
OREM UT
84057-1909
US

IV. Provider business mailing address

2943 W PARKWAY BLVD STE 67
SALT LAKE CITY UT
84119-1986
US

V. Phone/Fax

Practice location:
  • Phone: 801-784-8740
  • Fax: 801-618-2491
Mailing address:
  • Phone: 801-784-8740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DANIEL R PATTY
Title or Position: OWNER
Credential: DPM
Phone: 801-386-2364