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Organization

LEGACY DERMATOLOGY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JARED REX HEATON D.O. (PHYSICIAN)
(435) 770-9247
Entity
Organization

Contact information

Practice address
320 W 500 S, SUITE 210, BOUNTIFUL, UT 84010-7218
(385) 312-0650
(385) 743-3333
Mailing address
1535 LAKEVIEW DR, BOUNTIFUL, UT 84010-1561
(435) 770-9247

Taxonomy

Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
9017921-1204
UT

Other

Enumeration date
09/14/2014
Last updated
09/14/2014
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