Individual
ANN PAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3580 W 9000 S, WEST JORDAN, UT 84088-8812
(801) 561-8888
Mailing address
144 S 500 E, 2ND FLOOR, SALT LAKE CITY, UT 84102-1907
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
165537-1205
UT
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
165537-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06520
—
UT
Enumeration date
04/03/2006
Last updated
05/04/2010
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