Organization Name: | UTAH PODIATRY GROUP PC |
NPI Number: | 1033570619 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SCOTT A CLARK (DPM/PARTNER) |
Mailing Address: | 185 S 400 E Ste 100 Bountiful |
State: | UT US |
Postal Code: | 840104801 |
Phone Number: | 8012925070 |
Fax Number: | 8017740735 |
NPI Enumeration Date: | 03/10/2016 |
NPI Last Update Date: | 03/10/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |