Healthcare Provider Details

I. General information

NPI: 1992099220
Provider Name (Legal Business Name): JOSEPH MICHAEL LETOURNEAU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF UTAH HEALTH, DEPT OF OBGYN, 30 N 1900 E R
SALT LAKE CITY UT
84105
US

IV. Provider business mailing address

UNIVERSITY OF UTAH HEALTH, DEPT OF OBGYN, 30 N 1900 E R
SALT LAKE CITY UT
84105
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-3834
  • Fax:
Mailing address:
  • Phone: 801-581-3834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number10830605-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: