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General NPI Number Information
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NPI Number | 1104946847
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Entity Type | Individual
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Provider Name | SPENCER HEATON MD
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Gender | Male
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 07/11/2013
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Provider Practice Location Address
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Address Line | 680 E MAIN ST SUITE 202
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City | LEHI
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State | UT
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Zip | 84043-2241
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Country | US
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Telephone | 801-768-2755
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Fax | 801-768-2658
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Provider Business Mailing Address
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Address Line | 680 E MAIN ST SUITE 202
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City | LEHI
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State | UT
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Zip | 84043-2241
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Country | US
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Telephone | 801-768-2755
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Fax | 801-768-2658
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 8447939-1205
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License Number State | UT
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