Healthcare Provider Details

I. General information

NPI: 1962923433
Provider Name (Legal Business Name): VALLEY OBSTETRICS AND GYNECOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E 3900 S STE 200
SALT LAKE CITY UT
84124-1368
US

IV. Provider business mailing address

585 N 500 W
PROVO UT
84601-1548
US

V. Phone/Fax

Practice location:
  • Phone: 385-347-5450
  • Fax: 385-474-6961
Mailing address:
  • Phone: 801-756-9635
  • Fax: 801-216-8357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number6019946-1205
License Number StateUT

VIII. Authorized Official

Name: DANA MORRISON
Title or Position: CREDENTIALING
Credential:
Phone: 801-374-5000