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General NPI Number Information
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NPI Number | 1598113979
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Entity Type | Organization
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Legal Business Name | WASATCH WEIGHT CONTROL
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 05/26/2016
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Provider Practice Location Address
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Address Line | 1543 W 12600 S
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City | RIVERTON
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State | UT
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Zip | 84065-7175
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Country | US
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Telephone | 801-671-1124
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Fax |
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Provider Business Mailing Address
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Address Line | 6528 S CANYON RANCH RD
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City | SALT LAKE CITY
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State | UT
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Zip | 84121-6366
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Country | US
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Telephone | 801-671-1124
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. SCOTT EPSTEIN
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Credential | DO
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Telephone | 801-671-1124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VB0002X
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Taxonomy Name | Obesity Medicine (Obstetrics & Gynecology) Physician
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License Number | 5423934-1204
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License Number State | UT
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