Healthcare Provider Details

I. General information

NPI: 1083716955
Provider Name (Legal Business Name): LARRY E URRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 W SOUTH JORDAN PKWY STE 103
SOUTH JORDAN UT
84095
US

IV. Provider business mailing address

1325 W SOUTH JORDAN PKWY STE 103
SOUTH JORDAN UT
84095-9060
US

V. Phone/Fax

Practice location:
  • Phone: 801-232-6556
  • Fax: 18-987-8467
Mailing address:
  • Phone: 801-232-6556
  • Fax: 801-987-8467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number177611-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number177611-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number177611-1205
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number177611-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: