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Organization
DEPARTMENT OF PEDIATRICS UNIVERSITY OF UTAH
Active
Organization
DEPARTMENT OF PEDIATRICS UNIVERSITY OF UTAH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD B CLARK MD (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, PEDS ADMIN, SALT LAKE CITY, UT 84108-1220
(801) 587-7400
(801) 587-7417
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003057700
—
ID
05
—
100500257
—
NV
05
—
176668501
—
TX
05
—
200020440A
—
OK
05
—
200426530A
—
IN
05
—
7038870
—
WA
05
—
806902200
—
ID
05
—
911948500
—
FL
05
—
94001963
—
CO
05
—
G0749
—
NM
Enumeration date
05/24/2006
Last updated
09/06/2011
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