Healthcare Provider Details

I. General information

NPI: 1912058942
Provider Name (Legal Business Name): UTAH CANCER SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 S 700 E STE 100
SALT LAKE CITY UT
84106-1466
US

IV. Provider business mailing address

10808 S RIVER FRONT PKWY STE 400
SOUTH JORDAN UT
84095-5761
US

V. Phone/Fax

Practice location:
  • Phone: 801-270-2253
  • Fax: 801-267-5608
Mailing address:
  • Phone: 801-262-9494
  • Fax: 801-266-2074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number5153A
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number62476691704
License Number StateUT

VIII. Authorized Official

Name: WALTER MOYER
Title or Position: CEO
Credential:
Phone: 801-262-9494