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Organization
ROCKY MOUNTAIN FOOT AND ANKLE CLINIC
Active
Organization
ROCKY MOUNTAIN FOOT AND ANKLE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KELLY ALLAN GOMEZ D.P.M. (PODIATRIST)
(801) 375-6677
Entity
Organization
Contact information
Practice address
777 N 500 W, SUITE 105, PROVO, UT 84601-1541
(801) 375-6677
(801) 375-0346
Mailing address
777 N 500 W STE 105, PROVO, UT 84601-5032
(801) 375-6677
(801) 375-0346
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
367951
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529084511004
—
UT
Enumeration date
11/21/2006
Last updated
08/04/2008
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