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General NPI Number Information
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NPI Number | 1548308067
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Entity Type | Organization
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Legal Business Name | SKIN PATHOLOGY CONSULTANTS OF UTAH
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 10/29/2012
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Provider Practice Location Address
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Address Line | 168 E 5900 S STE C104
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City | MURRAY
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State | UT
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Zip | 84107-7287
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Country | US
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Telephone | 801-261-3007
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Fax | 801-263-6703
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Provider Business Mailing Address
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Address Line | 168 E 5900 S STE C104
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City | MURRAY
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State | UT
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Zip | 84107-7287
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Country | US
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Telephone | 801-261-3007
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Fax | 801-263-6703
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Authorized Official
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Title or Position | DIRECTOR LED
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Name | DR. PATRICIA ANN VITALE
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Credential | MD
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Telephone | 801-261-3007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZD0900X
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Taxonomy Name | Dermatopathology (Pathology) Physician
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License Number | 5228084-1205
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License Number State | UT
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