Healthcare Provider Details

I. General information

NPI: 1871090555
Provider Name (Legal Business Name): SARA ELIZABETH WALKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 06/16/2024
Certification Date: 06/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2870 E 3300 S
SALT LAKE CITY UT
84109-2821
US

IV. Provider business mailing address

2870 E 3300 S
SALT LAKE CITY UT
84109-2821
US

V. Phone/Fax

Practice location:
  • Phone: 385-500-3300
  • Fax: 385-242-7975
Mailing address:
  • Phone: 385-500-3300
  • Fax: 385-242-7975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number287262
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: