Healthcare Provider Details

I. General information

NPI: 1356637409
Provider Name (Legal Business Name): TAYLOR G WRIGHT D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 S 3000 E STE 300
SALT LAKE CITY UT
84121-6977
US

IV. Provider business mailing address

6405 S 3000 E STE 300
SALT LAKE CITY UT
84121-6977
US

V. Phone/Fax

Practice location:
  • Phone: 801-266-3113
  • Fax: 801-266-5633
Mailing address:
  • Phone: 801-266-3113
  • Fax: 801-266-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberP-249
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2057
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number8369993-0501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: