Healthcare Provider Details

I. General information

NPI: 1770050221
Provider Name (Legal Business Name): VALLEY OBSTETRICS AND GYNECOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N STATE ST STE 105
PROVO UT
84604-1354
US

IV. Provider business mailing address

585 N 500 W
PROVO UT
84601-1548
US

V. Phone/Fax

Practice location:
  • Phone: 801-655-5245
  • Fax: 801-702-1260
Mailing address:
  • Phone: 801-374-1801
  • Fax: 801-216-8357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: ADAM RASMUSSEN
Title or Position: CEO
Credential:
Phone: 801-374-1802