Healthcare Provider Details

I. General information

NPI: 1598113979
Provider Name (Legal Business Name): WASATCH WEIGHT CONTROL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1543 W 12600 S
RIVERTON UT
84065-7175
US

IV. Provider business mailing address

6528 S CANYON RANCH RD
SALT LAKE CITY UT
84121-6366
US

V. Phone/Fax

Practice location:
  • Phone: 801-671-1124
  • Fax:
Mailing address:
  • Phone: 801-671-1124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VB0002X
TaxonomyObesity Medicine (Obstetrics & Gynecology) Physician
License Number5423934-1204
License Number StateUT

VIII. Authorized Official

Name: DR. SCOTT EPSTEIN
Title or Position: MANAGING MEMBER
Credential: DO
Phone: 801-671-1124