Healthcare Provider Details

I. General information

NPI: 1689553158
Provider Name (Legal Business Name): UTAH MEDICAL ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 S 500 W STE B
WOODS CROSS UT
84010-8252
US

IV. Provider business mailing address

41 E 400 N # 332
LOGAN UT
84321-4020
US

V. Phone/Fax

Practice location:
  • Phone: 385-340-3130
  • Fax: 435-355-3707
Mailing address:
  • Phone: 385-340-3130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JUSTEN WATKINS
Title or Position: CMO
Credential: DO
Phone: 385-340-3130