Organization
PROVAS OF SALT LAKE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN HEWETT M.D. (MEDICAL DIRECTOR)
(801) 386-4240
Entity
Organization
Contact information
Practice address
909 E 9400 S, SANDY, UT 84094-5514
(801) 386-4240
Mailing address
909 E 9400 S, SANDY, UT 84094-5514
(801) 386-4240
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
—
Other
Enumeration date
04/26/2019
Last updated
04/26/2019
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