Healthcare Provider Details

I. General information

NPI: 1124837646
Provider Name (Legal Business Name): UTAH GASTROENTEROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10150 S PETUNIA WAY STE B
SANDY UT
84092-4328
US

IV. Provider business mailing address

1187 E 3900 S
SALT LAKE CITY UT
84124-1201
US

V. Phone/Fax

Practice location:
  • Phone: 801-619-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE MORRIS GABRENAS
Title or Position: ADMINISTRATOR
Credential:
Phone: 801-944-3191