Healthcare Provider Details

I. General information

NPI: 1346180346
Provider Name (Legal Business Name): SPENCER DOUGLAS BEAUDETTE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HELIX BUILDING 5050 30 NORTH MARIO CAPECCHI DRIVE
SALT LAKE CITY UT
84112
US

IV. Provider business mailing address

HELIX BUILDING 5050 30 NORTH MARIO CAPECCHI DRIVE
SALT LAKE CITY UT
84112
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-6393
  • Fax: 801-581-4367
Mailing address:
  • Phone: 801-581-6393
  • Fax: 801-581-4367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: