Healthcare Provider Details

I. General information

NPI: 1164876918
Provider Name (Legal Business Name): JOSHUA NELSON SPEIRS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1157 N 300 W STE 302
PROVO UT
84604-6124
US

IV. Provider business mailing address

1157 N 300 W STE 302
PROVO UT
84604-6124
US

V. Phone/Fax

Practice location:
  • Phone: 801-357-4470
  • Fax: 801-357-4473
Mailing address:
  • Phone: 801-357-4470
  • Fax: 801-357-4473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number12793565-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number12793565-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA151041
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: