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Organization
PREMIER PROVIDER HEALTH UTAH PLLC
Active
Organization
PREMIER PROVIDER HEALTH UTAH PLLC
Active
Other names
Wound Integrity Utah
Organization subpart
No
Provider details
NPI number
Authorized official
NORA LOPEZ (AUTHORIZED OFFICIAL)
(346) 239-9469
Entity
Organization
Contact information
Practice address
5475 S 500 E, OGDEN, UT 84405-6905
(801) 479-2111
Mailing address
1 CHISHOLM TRAIL RD STE 5200, ROUND ROCK, TX 78681-5090
(512) 202-3830
(512) 354-1106
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
207RI0200X
Infectious Disease Physician
—
NULL
207RI0200X
Infectious Disease Physician
—
—
Other
Enumeration date
11/19/2019
Last updated
11/13/2024
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