Organization
UOU PEDIATRIC ORTHOPEDICS
Active
Organization
UOU PEDIATRIC ORTHOPEDICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALAN KENDRICK STOTTS MD (DEPARTMENT CHAIR)
(801) 588-3900
Entity
Organization
Contact information
Practice address
100 MARIO CAPECCHI DR, SALT LAKE CITY, UT 84112-8924
(801) 588-3900
Mailing address
PO BOX 58886, SALT LAKE CITY, UT 84158-0886
(801) 213-3800
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
—
207XP3100X
Pediatric Orthopaedic Surgery Physician
Primary
—
—
207XS0117X
Orthopaedic Surgery of the Spine Physician
—
—
207XX0801X
Orthopaedic Trauma Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100500963
NEVADA MEDICAID
NV
01
—
122233300
WYOMING MEDICAID
WY
01
—
200072630A
OKLAHOMA MEDICAID
OK
01
—
805675500
IDAHO MEDICAID
ID
Enumeration date
08/24/2006
Last updated
09/06/2011
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