Healthcare Provider Details

I. General information

NPI: 1922096114
Provider Name (Legal Business Name): DERMATOLOGY DIVISION UNIVERSITY OF UTAH MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

PO BOX 841052
LOS ANGELES CA
90084-1052
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-6340
  • Fax: 801-587-6346
Mailing address:
  • Phone: 801-581-2955
  • Fax: 801-587-6346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number1617461205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number1617461205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number1617461205
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number1617461205
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number1617461205
License Number StateUT
# 6
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number1617461205
License Number StateUT
# 7
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number1617461205
License Number StateUT
# 8
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number1617461205
License Number StateUT

VIII. Authorized Official

Name: DR. SAMUEL FINLAYSON
Title or Position: CHIEF CLINICAL OFFICER
Credential:
Phone: 801-587-6336