Healthcare Provider Details

I. General information

NPI: 1215843230
Provider Name (Legal Business Name): REBECCA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

558 N GRAND TOUR DR
SARATOGA SPRINGS UT
84045-4846
US

IV. Provider business mailing address

558 N GRAND TOUR DR
SARATOGA SPRINGS UT
84045-4846
US

V. Phone/Fax

Practice location:
  • Phone: 801-824-4028
  • Fax:
Mailing address:
  • Phone: 801-824-4028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9267038-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: