MEDICARE: DR. WILLARD Z MAUGHAN M.D.

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	207NS0135X	Procedural Dermatology Physician	1614591205	UT

General Provider Information

NPI Number	:	1235125063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLARD Z MAUGHAN M.D.

Provider Business Mailing Address
First Line	:	6028 S RIDGELINE DR STE 200
Second Line	:
City	:	SOUTH OGDEN
State	:	UT
Zip	:	84405-6906
Country	:	US
Telephone Number	:	801-475-5210
Fax Number	:	801-475-5209

Provider Business Practice Location Address
First Line	:	6028 S RIDGELINE DR
Second Line	:	#200
City	:	SOUTH OGDEN
State	:	UT
Zip	:	84405-6914
Country	:	US
Telephone Number	:	801-475-5210
Fax Number	:	801-475-5209

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	08/11/2015

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