Organization
UNIVERSITY OF UTAH GENERAL PEDIATRICS
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) 588-2233
(801) 588-2236
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
—
100501970
—
NV
05
—
122032200
—
WY
05
—
47157844
—
CO
05
—
7116627
—
WA
05
—
805687000
—
ID
Enumeration date
06/14/2006
Last updated
09/06/2011
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