Healthcare Provider Details

I. General information

NPI: 1609280486
Provider Name (Legal Business Name): ALYSE WILLIAMS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E 3900 S SUITE 260
SALT LAKE CITY UT
84124-1348
US

IV. Provider business mailing address

1250 E 3900 S SUITE 260
SALT LAKE CITY UT
84124-1348
US

V. Phone/Fax

Practice location:
  • Phone: 801-265-2000
  • Fax: 801-265-2008
Mailing address:
  • Phone: 801-265-2000
  • Fax: 801-265-2008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9542527-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: