Healthcare Provider Details

I. General information

NPI: 1093037376
Provider Name (Legal Business Name): J PRESTON HUGHES A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2010
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E 3900 S STE 320
SALT LAKE CITY UT
84124-1350
US

IV. Provider business mailing address

1250 E 3900 S STE 320
SALT LAKE CITY UT
84124-1350
US

V. Phone/Fax

Practice location:
  • Phone: 801-266-1409
  • Fax: 801-266-0685
Mailing address:
  • Phone: 801-266-1409
  • Fax: 801-266-0685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number151578-1205
License Number StateUT

VIII. Authorized Official

Name: DR. J PRESTON HUGHES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 801-266-1409