Healthcare Provider Details

I. General information

NPI: 1073838058
Provider Name (Legal Business Name): ADAM L WARE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

465 N 800 E
NEPHI UT
84648-1357
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-5702
  • Fax: 801-662-5755
Mailing address:
  • Phone: 801-380-0810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number8153518-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: