Organization
UNIVERSITY OF UTAH PEDIATRIC NEUROLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD B CLARK MD (CHAIRMAN)
(801) 587-7400
Entity
Organization
Contact information
Practice address
3741 W 12600 S, RIVERTON, UT 84065-7215
(801) 285-4000
Mailing address
100 MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-5696
(801) 662-5699
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
48547254405
UT
Other
Enumeration date
07/08/2010
Last updated
07/08/2010
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