Healthcare Provider Details

I. General information

NPI: 1932385671
Provider Name (Legal Business Name): SUZANNE M YANDOW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MARIO CAPECCHI DR 4550
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

PO BOX 413026
SALT LAKE CITY UT
84141-3026
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-5600
  • Fax:
Mailing address:
  • Phone: 801-213-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberM8442
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: