# PEDIATRIC GENETICS DEPARTMENT OF UNIVERSITY OF UTAH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629022827
- **Authorized official:** DR. EDWARD B CLARK MD (CHAIR)
- **Authorized official phone:** (801) 587-7400

## Contact information

- **Practice address:** 50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
- **Practice address phone:** (801) 581-8943
- **Practice address fax:** (801) 585-7252
- **Mailing address:** 295 CHIPETA WAY, PEDS ADMIN, SALT LAKE CITY, UT 84108-1220
- **Mailing address phone:** (801) 587-7400
- **Mailing address fax:** (801) 587-7417

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207SG0201X | Clinical Genetics (M.D.) Physician | — | NULL | Yes |
| 207SG0201X | Clinical Genetics (M.D.) Physician | — | — | Yes |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |

## Other

- **Enumeration date:** 05/20/2006
- **Last updated:** 09/06/2011