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Organization

MEDICAL NEUROSCIENCE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. WILLIAM T COULDWELL MD (DEPT CHAIR)
(801) 581-6909
Entity
Organization

Contact information

Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
(801) 581-2121
(801) 581-4385
Mailing address
50 N MEDICAL DR, U OF U SOM DEPT OF NEUROSURGERY #3B409, SALT LAKE CITY, UT 84132-0001
(801) 581-6909
(801) 581-4385

Taxonomy

Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
2084N0400X
Neurology Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100503241
NV
05
118163700
WY
05
806539400
ID
Enumeration date
09/20/2006
Last updated
09/06/2011
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