Healthcare Provider Details

I. General information

NPI: 1164461612
Provider Name (Legal Business Name): FREDERICK A HOTTES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 W 9000 S
WEST JORDAN UT
84088-8812
US

IV. Provider business mailing address

PO BOX 276
MIDVALE UT
84047-0276
US

V. Phone/Fax

Practice location:
  • Phone: 801-263-0810
  • Fax: 801-270-8170
Mailing address:
  • Phone: 801-263-0810
  • Fax: 801-270-8170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number159779-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: