Organization
ROCKY MOUNTAIN FOOT AND ANKLE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KELLY ALLAN GOMEZ D.P.M. (PODIATRIST)
(801) 375-6677
Entity
Organization
Contact information
Practice address
777 N 500 W, SUITE 105, PROVO, UT 84601-1541
(801) 375-6677
(801) 375-0346
Mailing address
777 N 500 W STE 105, PROVO, UT 84601-5032
(801) 375-6677
(801) 375-0346
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
367951
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529084511004
—
UT
Enumeration date
11/21/2006
Last updated
08/04/2008
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