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General NPI Number Information
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NPI Number | 1417983776
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF UTAH OB DIAGNOSTIC CENTER
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 50 N MEDICAL DR
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City | SALT LAKE CITY
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State | UT
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Zip | 84132-0001
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Country | US
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Telephone | 801-581-2719
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 58859
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City | SALT LAKE CITY
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State | UT
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Zip | 84158-0859
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Country | US
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Telephone | 801-585-5172
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Fax |
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Authorized Official
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Title or Position | DEPARTMENT CHAIR
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Name | C. MATTHEW PETERSON
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Credential | MD
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Telephone | 801-581-2719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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