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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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