Healthcare Provider Details

I. General information

NPI: 1801857271
Provider Name (Legal Business Name): ENT PROFESSIONAL ASSOCIATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 S 700 E STE 10
SLC UT
84107-2180
US

IV. Provider business mailing address

4000 S 700 E STE 10
SLC UT
84107-2180
US

V. Phone/Fax

Practice location:
  • Phone: 801-268-4141
  • Fax: 801-261-8609
Mailing address:
  • Phone: 801-268-4141
  • Fax: 801-261-8609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number5239
License Number StateUT

VIII. Authorized Official

Name: JERRY W SONKENS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 801-268-4141