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General NPI Number Information
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NPI Number | 1881729507
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Entity Type | Organization
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Legal Business Name | CENTRAL UTAH FOOT CLINIC, LLC
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | 150 W 800 N
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City | PROVO
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State | UT
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Zip | 84601-1624
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Country | US
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Telephone | 801-375-5353
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Fax | 801-375-5395
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Provider Business Mailing Address
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Address Line | 150 W 800 N
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City | PROVO
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State | UT
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Zip | 84601-1624
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Country | US
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Telephone | 801-375-5353
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Fax | 801-375-5395
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Authorized Official
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Title or Position | PARTNER
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Name | MARK F ROGERS
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Credential | D.P.M.
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Telephone | 801-375-5353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 102652-0501
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License Number State | UT
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