Healthcare Provider Details

I. General information

NPI: 1174452619
Provider Name (Legal Business Name): RIVERWOODS DERMATOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5314 N 250 W STE 220
PROVO UT
84604-7746
US

IV. Provider business mailing address

5314 N 250 W STE 220
PROVO UT
84604-7746
US

V. Phone/Fax

Practice location:
  • Phone: 801-225-8484
  • Fax: 801-225-6170
Mailing address:
  • Phone: 801-225-8484
  • Fax: 801-225-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD W PARKINSON
Title or Position: OWNER
Credential: MD
Phone: 801-225-8484