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General NPI Number Information
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NPI Number | 1518239177
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Entity Type | Organization
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Legal Business Name | UTAH PODIATRY GROUP LLC
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Dates
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Enumeration Date | 01/29/2012
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 8822 S REDWOOD RD SUITE E121
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City | WEST JORDAN
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State | UT
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Zip | 84088-9336
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Country | US
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Telephone | 801-505-5277
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Fax | 801-505-5280
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Provider Business Mailing Address
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Address Line | PO BOX 849795
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City | LOS ANGELES
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State | CA
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Zip | 90084-9795
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Country | US
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Telephone | 801-451-6060
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Fax | 801-797-9154
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Authorized Official
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Title or Position | DPM
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Name | DR. SCOTT A CLARK
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Credential | DPM
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Telephone | 801-505-5277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 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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