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Organization
PEDIATRIC SLEEP MEDICINE DEPARTMENT OF UNIVERSITY OF UTAH
Active
Organization
PEDIATRIC SLEEP MEDICINE 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) 662-1780
(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
—
—
2080S0012X
Pediatric Sleep Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100507109
—
NV
05
—
121236200
—
WY
05
—
807149100
—
ID
Enumeration date
11/06/2006
Last updated
09/06/2011
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