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General NPI Number Information
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NPI Number | 1548208028
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Entity Type | Individual
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Provider Name | DR. WILLIAM PIDWELL
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Gender | Male
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 08/31/2012
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Provider Practice Location Address
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Address Line | 750 ROUND VALLEY DR. SUITE 201
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City | PARK CITY
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State | UT
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Zip | 84060-5127
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Country | US
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Telephone | 435-649-7640
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Fax | 435-649-1365
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Provider Business Mailing Address
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Address Line | PO BOX 27128
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City | SALT LAKE CITY
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State | UT
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Zip | 84127-0128
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Country | US
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Telephone | 801-491-6482
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Fax |
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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 | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 5755327-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5755327-1205
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License Number State | UT
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