Healthcare Provider Details

I. General information

NPI: 1952491557
Provider Name (Legal Business Name): SALVADOR FERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 N 1250 E # 103
PAYSON UT
84651-5794
US

IV. Provider business mailing address

589 SOUTH STATE STREET
PROVO UT
84606-5056
US

V. Phone/Fax

Practice location:
  • Phone: 801-429-2000
  • Fax: 801-429-2001
Mailing address:
  • Phone: 801-429-2000
  • Fax: 801-429-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number378669-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number3786691205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: