Healthcare Provider Details

I. General information

NPI: 1881897908
Provider Name (Legal Business Name): DEIRDRE CONWAY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1446 W PLEASANT GROVE BLVD
PLEASANT GROVE UT
84062-3216
US

IV. Provider business mailing address

1446 W PLEASANT GROVE BLVD
PLEASANT GROVE UT
84062-3216
US

V. Phone/Fax

Practice location:
  • Phone: 801-785-5100
  • Fax:
Mailing address:
  • Phone: 801-785-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA99248
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberM-12884
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number8343768-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: