Healthcare Provider Details

I. General information

NPI: 1225006109
Provider Name (Legal Business Name): THOMAS C WINTER III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF UTAH DEPARTMENT OF RADIOLOGY 30 NORTH 1900 EAST #1A071
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

1627 MOHAWK WAY
SALT LAKE CITY UT
84108-3311
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-7553
  • Fax:
Mailing address:
  • Phone: 801-585-6108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number6992880-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: