Healthcare Provider Details

I. General information

NPI: 1083849723
Provider Name (Legal Business Name): KATHERINE DOUGLAS WESTMORELAND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3723 W 12600 S STE 450
RIVERTON UT
84065-7295
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-285-4543
  • Fax: 801-285-4540
Mailing address:
  • Phone: 801-285-4543
  • Fax: 801-285-4540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7771510-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: