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General NPI Number Information
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NPI Number | 1881945608
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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 | 09/20/2012
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 120 N 1220 E STE 12
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City | AMERICAN FORK
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State | UT
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Zip | 84003-2089
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Country | US
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Telephone | 801-756-4200
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Fax | 801-756-8252
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Provider Business Mailing Address
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Address Line | 120 N 1220 E STE 12
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City | AMERICAN FORK
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State | UT
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Zip | 84003-2089
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Country | US
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Telephone | 801-756-4200
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Fax | 801-756-8252
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Authorized Official
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Title or Position | OWNER
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Name | MARK ROGERS
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Credential |
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Telephone | 801-756-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 102652-0501
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License Number State | UT
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