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NPI Code Detail

MEDICARE: DR. REED FOGG M.D.

MEDICARE: DR. REED FOGG 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
1207XS0117XOrthopaedic Surgery of the Spine Physician147576-1205UT

General Provider Information

NPI Number : 1881663870
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. REED FOGG M.D.
Provider Business Mailing Address
First Line : 5770 SOUTH 250 EAST
Second Line : SUITE 135
City : SALT LAKE CITY
State : UT
Zip : 84107-8241
Country : US
Telephone Number : 801-314-2225
Fax Number : 801-314-2345
Provider Business Practice Location Address
First Line : 5770 SOUTH 250 EAST
Second Line : SUITE 135
City : SALT LAKE CITY
State : UT
Zip : 84107-8241
Country : US
Telephone Number : 801-314-2225
Fax Number : 801-314-2345
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2006
Last Update Date : 09/18/2014

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