Organization
WOODMEAD MEDICAL CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GAVIN N VAN STADEN M.D. (OWNER)
(801) 296-0600
Entity
Organization
Contact information
Practice address
3263 S HIGHWAY 89, SUITE 300, BOUNTIFUL, UT 84010-8555
(801) 296-0600
(801) 295-1700
Mailing address
3263 S HIGHWAY 89, SUITE 300, BOUNTIFUL, UT 84010-8555
(801) 296-0600
(801) 295-1700
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
284903-1205
UT
261Q00000X
Clinic/Center
Primary
5863514-1205
UT
Other
Enumeration date
07/15/2011
Last updated
07/15/2011
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