Healthcare Provider Details

I. General information

NPI: 1609193622
Provider Name (Legal Business Name): HUNTER REEVE UNDERHILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

127S 500 E SUITE 600
SALT LAKE CITY UT
84102-1971
US

V. Phone/Fax

Practice location:
  • Phone: 801-213-3599
  • Fax:
Mailing address:
  • Phone: 801-587-6336
  • Fax: 801-715-8228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberMD00048675
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207SG0202X
TaxonomyClinical Biochemical Genetics Physician
License Number9097278-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD00048675
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9097278-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: