Individual
L. SCOTT VANWAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
170 NORTH 1100 EAST, AMERICAN FORK, UT 84003
(801) 714-6570
Mailing address
PO BOX 430, SALT LAKE CITY, UT 84660-0430
(866) 898-7136
(616) 975-9827
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
359724
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107009651102
SELECT HEALTH
UT
01
—
659871
DESERET MUTUAL
UT
01
—
870636000VA1
EDUCATORS MUTUAL
UT
05
—
D2495
—
UT
Enumeration date
05/18/2006
Last updated
02/11/2010
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