Individual
DR. PHILIP LUKE BAESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
650 KOMAS DR, 200, SALT LAKE CITY, UT 84108-1229
(801) 581-5515
Mailing address
501 CHIPETA WAY, SALT LAKE CITY, UT 84108-1222
(801) 587-3102
Taxonomy
Speciality
Code
Description
License number
State
2084P0005X
Neurodevelopmental Disabilities Physician
Primary
363340-1205
UT
Other
Enumeration date
06/18/2006
Last updated
10/16/2021
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