Healthcare Provider Details

I. General information

NPI: 1538267877
Provider Name (Legal Business Name): MIDDLETON UROLOGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 E 100 S #110
SALT LAKE CITY UT
84102-1501
US

IV. Provider business mailing address

1060 E 100 S #110
SALT LAKE CITY UT
84102-1501
US

V. Phone/Fax

Practice location:
  • Phone: 801-531-9453
  • Fax: 801-531-9467
Mailing address:
  • Phone: 801-531-9453
  • Fax: 801-531-9467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: GEORGE MIDDLETON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 801-266-8664