Organization
UNIVERSITY OF UTAH PEDIATRIC SERVICES
Active
Parent organization
UNIVERSITY OF UTAH PEDIATRIC SERVICES
Other names
Pediatric Neurology - Idaho Falls
Organization subpart
Yes
Provider details
NPI number
Legal business name
UNIVERSITY OF UTAH PEDIATRIC SERVICES
Authorized official
EDWARD CLARK MD (DEPARTMENT CHAIR)
(801) 587-6336
Entity
Organization
Contact information
Practice address
1645 PANCHERI DR, IDAHO FALLS, ID 83402-3169
(208) 227-1460
Mailing address
PO BOX 841450, LOS ANGELES, CA 90084-1450
(801) 213-3900
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
—
—
Other
Enumeration date
01/12/2017
Last updated
05/21/2020
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