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General NPI Number Information
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NPI Number | 1689868523
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Entity Type | Organization
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Legal Business Name | UTAH HEMATOLOGY ONCOLOGY PC
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 06/16/2014
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Provider Practice Location Address
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Address Line | 2132 N 1700 W SUITE 301
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City | LAYTON
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State | UT
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Zip | 84041-7057
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Country | US
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Telephone | 801-775-9990
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Fax | 801-479-1479
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Provider Business Mailing Address
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Address Line | 5290 S 400 E
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City | OGDEN
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State | UT
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Zip | 84405-7194
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Country | US
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Telephone | 801-476-1777
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Fax | 801-479-1479
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. DAVID C PITTAM
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Credential | MHA
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Telephone | 801-476-1777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 4813
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License Number State | UT
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