Healthcare Provider Details

I. General information

NPI: 1972186872
Provider Name (Legal Business Name): MITCHELL WASDEN COONEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W 2700 N
PLEASANT VIEW UT
84404-4791
US

IV. Provider business mailing address

PO BOX 5546
DENVER CO
80217-5546
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-3600
  • Fax: 801-475-3601
Mailing address:
  • Phone: 801-475-3500
  • Fax: 801-475-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13823396-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: