Organization
EDWARD G. SOUTHWICK, M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD GLEN SOUTHWICK M.D. (PRESIDENT)
(801) 966-1403
Entity
Organization
Contact information
Practice address
3465 S 4155 W, SUITE 1, WEST VALLEY CITY, UT 84120-2076
(801) 966-1403
(801) 964-6478
Mailing address
3465 S 4155 W, SUITE 1, WEST VALLEY CITY, UT 84120-2076
(801) 966-1403
(801) 964-6478
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
071157009
RAILROAD MEDICARE
UT
Enumeration date
09/13/2012
Last updated
09/13/2012
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