Healthcare Provider Details

I. General information

NPI: 1063481646
Provider Name (Legal Business Name): DR. MICHAEL P EYRE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E 800 N
SPANISH FORK UT
84660
US

IV. Provider business mailing address

114 E 800 N
SPANISH FORK UT
84660-1232
US

V. Phone/Fax

Practice location:
  • Phone: 801-794-1490
  • Fax: 801-794-1495
Mailing address:
  • Phone: 801-794-1490
  • Fax: 801-794-1495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number5371038-1204
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number537110371204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: