Organization
PEDIATRIC BONE MARROW TRANSPLANT DEPARTMENT OF UNIVERSITY OF UTAH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD B CLARK MD (CHAIR)
(801) 587-7400
Entity
Organization
Contact information
Practice address
100 N MEDICAL DR, SALT LAKE CITY, UT 84113-1103
(801) 662-4700
(801) 662-4705
Mailing address
295 CHIPETA WAY, SALT LAKE CITY, UT 84108-1220
(801) 587-7400
(801) 587-7417
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100507113
—
NV
05
—
121226500
—
WY
05
—
807148000
—
ID
01
—
807148400
MEDICAID IDAHO - MIDLEVEL
ID
Enumeration date
08/13/2006
Last updated
09/15/2008
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