Healthcare Provider Details

I. General information

NPI: 1134758162
Provider Name (Legal Business Name): ZACHARY THOMAS COATES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 09/16/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HELIX: 30 N MARIO CAPECCHI RM 2S100
SALT LAKE CITY UT
84112
US

IV. Provider business mailing address

HELIX: 30 N MARIO CAPECCHI RM 2S100
SALT LAKE CITY UT
84112
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2121
  • Fax:
Mailing address:
  • Phone: 801-581-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.148123
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number14137811-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: