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General NPI Number Information
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NPI Number | 1457737579
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Entity Type | Organization
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Legal Business Name | UTAH PODIATRY GROUP PC
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Dates
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Enumeration Date | 07/31/2015
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Last Update Date | 04/21/2020
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Provider Practice Location Address
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Address Line | 1973 NORTH STATE STREET
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City | PROVO
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State | UT
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Zip | 84604-1012
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Country | US
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Telephone | 801-373-2499
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Fax | 801-373-5200
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Provider Business Mailing Address
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Address Line | PO BOX 30015 DEPT 380
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City | SALT LAKE CITY
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State | UT
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Zip | 84130-0015
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Country | US
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Telephone | 801-373-2499
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Fax | 801-373-5200
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | SUSAN MARIE TAYLOR
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Credential |
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Telephone | 801-505-0821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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