Organization
UTAH PODIATRY GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT A CLARK (DPM)
(801) 505-5277
Entity
Organization
Contact information
Practice address
82 S 1100 E STE 301, SALT LAKE CITY, UT 84102
(801) 505-5277
(801) 505-5280
Mailing address
PO BOX 540610, N SALT LAKE, UT 84054-0610
(801) 505-0821
(801) 505-0803
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
106339-0501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106339-0501
LICENSE
UT
Enumeration date
01/23/2018
Last updated
09/03/2019
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