Healthcare Provider Details

I. General information

NPI: 1093343980
Provider Name (Legal Business Name): MATIAS A CALQUIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

589 S STATE ST
PROVO UT
84606-5056
US

IV. Provider business mailing address

589 S STATE ST
PROVO UT
84606-5056
US

V. Phone/Fax

Practice location:
  • Phone: 801-420-2000
  • Fax:
Mailing address:
  • Phone: 801-429-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12374118-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: