Healthcare Provider Details

I. General information

NPI: 1316923113
Provider Name (Legal Business Name): KEITH OWEN HORWOOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 S 3200 W
SALT LAKE CITY UT
84118-2822
US

IV. Provider business mailing address

1876 SUZETTE CIR
SALT LAKE CITY UT
84106-3914
US

V. Phone/Fax

Practice location:
  • Phone: 801-964-6214
  • Fax:
Mailing address:
  • Phone: 801-487-8187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number173664-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: