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General NPI Number Information
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NPI Number | 1518591874
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Entity Type | Organization
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Legal Business Name | SLC PLASTIC SURGERY LLC
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Dates
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Enumeration Date | 02/26/2020
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Last Update Date | 02/26/2020
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Provider Practice Location Address
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Address Line | 6686 HIGHLAND DRIVE
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City | COTTONWOOD HEIGHTS
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State | UT
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Zip | 84121
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Country | US
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Telephone | 801-647-5522
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Fax |
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Provider Business Mailing Address
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Address Line | 7001 S 900 E STE 100
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City | MIDVALE
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State | UT
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Zip | 84047-1700
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Country | US
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Telephone | 801-647-5522
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. BRIAN C REUBEN
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Credential | MD
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Telephone | 801-647-5522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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