Healthcare Provider Details

I. General information

NPI: 1609787001
Provider Name (Legal Business Name): MOBILE DERMATOLOGY SOLUTIONS OF UTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6061 W 9860 S STE A
WEST JORDAN UT
84081-5707
US

IV. Provider business mailing address

6061 W 9860 S STE A
WEST JORDAN UT
84081-5707
US

V. Phone/Fax

Practice location:
  • Phone: 888-506-8838
  • Fax:
Mailing address:
  • Phone: 888-506-8838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JORDAN HEAPS
Title or Position: OWNER
Credential:
Phone: 386-405-7810