Organization
UTAH PODIATRY GROUP PC
Active
Parent organization
UTAH PODIATRY GROUP PC
Other names
Advanced Foot & Ankle Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
UTAH PODIATRY GROUP PC
Authorized official
SUSAN MARIE TAYLOR (DIRECTOR OF OPERATIONS)
(801) 505-0821
Entity
Organization
Contact information
Practice address
1973 NORTH STATE STREET, PROVO, UT 84604-1012
(801) 373-2499
(801) 373-5200
Mailing address
PO BOX 30015 DEPT 380, SALT LAKE CITY, UT 84130-0015
(801) 373-2499
(801) 373-5200
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6152070001
DME PTAN
UT
Enumeration date
07/31/2015
Last updated
04/21/2020
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