Healthcare Provider Details

I. General information

NPI: 1841618444
Provider Name (Legal Business Name): ERIC WESTON INNES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W 800 N STE 100
OREM UT
84057
US

IV. Provider business mailing address

1055 N 500 W ATTN CREDENTIALING
PROVO UT
84604-2501
US

V. Phone/Fax

Practice location:
  • Phone: 801-373-7350
  • Fax: 801-224-5337
Mailing address:
  • Phone: 801-354-8225
  • Fax: 801-581-4367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number9538408-1205
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number9538408-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: