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Organization
PEDIATRIC IMMUNOLOGY DEPARTMENT OF UNIVERSITY OF UTAH
Active
Organization
PEDIATRIC IMMUNOLOGY DEPARTMENT OF UNIVERSITY OF UTAH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD B CLARK MD (DEPT CHAIR)
(801) 587-7400
Entity
Organization
Contact information
Practice address
100 N MEDICAL DR, SALT LAKE CITY, UT 84113-1103
(801) 588-2000
(801) 587-7417
Mailing address
295 CHIPETA WAY, U OF U SOM DEPT OF PEDIATRICS, SALT LAKE CITY, UT 84108-1220
(801) 587-7400
(801) 587-7417
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
2080P0216X
Pediatric Rheumatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100507111
—
NV
05
—
121447100
—
WY
05
—
807148200
—
ID
05
—
807148300
—
ID
Enumeration date
09/20/2006
Last updated
09/06/2011
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