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Organization
UTAH MODERN MEDICAL LLC
Active
Organization
UTAH MODERN MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVE BULLOCK (OWNER)
(385) 455-7170
Entity
Organization
Contact information
Practice address
3300 N ASHTON BLVD STE 450, LEHI, UT 84048-5340
(385) 455-7170
(888) 823-5887
Mailing address
3300 N ASHTON BLVD STE 450, LEHI, UT 84048-5340
(385) 455-7170
(888) 823-5887
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
05/10/2022
Last updated
09/17/2026
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