Healthcare Provider Details

I. General information

NPI: 1437670098
Provider Name (Legal Business Name): WILLIAM STANLEY GARZON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 07/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 W 1000 N
SALT LAKE CITY UT
84116-1654
US

IV. Provider business mailing address

1536 S GREEN ST APT 3
SALT LAKE CITY UT
84105-2156
US

V. Phone/Fax

Practice location:
  • Phone: 801-654-1784
  • Fax:
Mailing address:
  • Phone: 801-654-1784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9108148-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: