MEDICARE: SCOTT MARTIN SOULIER DPM, MSPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	0582870001	UT
2	213ES0103X	Foot & Ankle Surgery Podiatrist	102832-0501	UT

General Provider Information

NPI Number	:	1043213168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT MARTIN SOULIER DPM, MSPH

Provider Business Mailing Address
First Line	:	4578 HIGHLAND DR
Second Line	:	STE 380
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4243
Country	:	US
Telephone Number	:	801-274-9060
Fax Number	:	801-274-9064

Provider Business Practice Location Address
First Line	:	4578 HIGHLAND DR
Second Line	:	STE 380
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4243
Country	:	US
Telephone Number	:	801-274-9060
Fax Number	:	801-274-9064

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	04/24/2018

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