Healthcare Provider Details
I. General information
NPI: 1699179754
Provider Name (Legal Business Name): UNIVERSITY OF UTAH SPECIALTY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 10/20/2014
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:
III. Provider practice location address
50 N MEDICAL DR
SALT LAKE CITY UT
84132-0100
US
IV. Provider business mailing address
PO BOX 841450
LOS ANGELES CA
90084-1450
US
V. Phone/Fax
- Phone: 801-213-2995
- Fax:
- Phone: 801-213-3900
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207VX0201X |
| Taxonomy | Gynecologic Oncology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
SAMUEL
FINLAYSON
Title or Position: CHIEF CLINICAL OFFICER
Credential: MD
Phone: 801-587-6336