Organization
UNIVERSITY OF UTAH PEDIATRIC CARDIOLOGY ELECTROPHYSIOLOGY SVCS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD B CLARK MD (CHAIR)
(801) 587-7400
Entity
Organization
Contact information
Practice address
100 MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-5400
(801) 662-5404
Mailing address
295 CHIPETA WAY, SALT LAKE CITY, UT 84108-1287
(801) 587-7400
(801) 587-7417
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
2080P0202X
Pediatric Cardiology Physician
—
—
Other
Enumeration date
04/26/2012
Last updated
05/22/2012
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