Organization
IDENTITY HORMONES UT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TEAH SMITH (CREDENTIALING MANAGER)
(901) 205-3999
Entity
Organization
Contact information
Practice address
1327 E 2100 S STE 101, SALT LAKE CITY, UT 84105-3763
(602) 354-3925
Mailing address
1327 E 2100 S STE 101, SALT LAKE CITY, UT 84105-3763
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
06/29/2022
Last updated
11/13/2023
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