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General NPI Number Information
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NPI Number | 1881419133
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Entity Type | Organization
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Legal Business Name | UTAH GASTROENTEROLOGY, LLC
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 1393 E SEGO LILY DR
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City | SANDY
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State | UT
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Zip | 84092-4350
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Country | US
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Telephone | 801-619-9000
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Fax | 801-619-9000
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Provider Business Mailing Address
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Address Line | 1187 E 3900 S
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City | SALT LAKE CITY
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State | UT
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Zip | 84124-1201
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | CHRISTINE MORRIS GABRENAS
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Credential |
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Telephone | 801-944-3191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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