Healthcare Provider Details

I. General information

NPI: 1790794568
Provider Name (Legal Business Name): ANDREW P SOISSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF UTAH/DEPARTMENT OBGYN 30N, 1900E, SUITE 2B200
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

UNIVERSITY OF UTAH/DEPARTMENT OBGYN 30N, 1900E, SUITE 2B200
SALT LAKE CITY UT
84132-0001
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-0067
  • Fax:
Mailing address:
  • Phone: 801-585-0067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number52954801205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number5295480-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: