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Organization

UNIVERSITY OF UTAH DIVISION OF PEDIATRIC NEUROSURGERY

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
100 N MEDICAL DR, SUITE 2400, SALT LAKE CITY, UT 84113-1103
(801) 588-3400
(801) 588-3409
Mailing address
50 N MEDICAL DR, 3B409-SOM, SALT LAKE CITY, UT 84132-0001
(801) 581-6909
(801) 581-4385

Taxonomy

Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
2086S0120X
Pediatric Surgery Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003073800
ID
05
100389310A
IN
05
100501144
NV
05
116059100
WY
05
200019110A
OK
05
29584205
CO
05
7123755
WA
05
837253
NM
05
X9X042036
TX
Enumeration date
08/31/2006
Last updated
09/06/2011
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