Healthcare Provider Details

I. General information

NPI: 1700574530
Provider Name (Legal Business Name): MATTHEW WOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5974 FASHION POINT DR STE 140
SOUTH OGDEN UT
84403-4838
US

IV. Provider business mailing address

415 MEDICAL DR STE A100
BOUNTIFUL UT
84010-4995
US

V. Phone/Fax

Practice location:
  • Phone: 801-683-1062
  • Fax:
Mailing address:
  • Phone: 801-683-1062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: