Organization
PREMIER PLASTIC SURGERY GROUP OF UTAH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE WHITE (SECRETARY)
(801) 571-2020
Entity
Organization
Contact information
Practice address
11762 S STATE ST STE 220, DRAPER, UT 84020-7156
(801) 571-2020
(801) 571-6899
Mailing address
11762 S STATE ST STE 220, DRAPER, UT 84020-7156
(801) 571-2020
(801) 571-6899
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
528276851028
—
UT
05
—
529316986001
—
UT
Enumeration date
02/11/2010
Last updated
01/19/2011
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