Healthcare Provider Details

I. General information

NPI: 1821757303
Provider Name (Legal Business Name): UTAH PODIATRY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E 3900 S STE 420
SALT LAKE CITY UT
84124-1355
US

IV. Provider business mailing address

PO BOX 849795
LOS ANGELES CA
90084-9795
US

V. Phone/Fax

Practice location:
  • Phone: 801-505-5277
  • Fax: 801-505-5280
Mailing address:
  • Phone: 801-505-5277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: SCOTT A CLARK
Title or Position: DPM
Credential:
Phone: 801-505-5277