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Organization

LONNIE PAULOS MD PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LEON E PAULOS MD (PRESIDENT)
(801) 476-9200
Entity
Organization

Contact information

Practice address
324 EAST 10TH AVENUE, STE 172, SALT LAKE CITY, UT 84103-3184
(801) 476-9200
(801) 476-9208
Mailing address
324 EAST 10TH AVENUE, STE 172, SALT LAKE CITY, UT 84103-3184
(801) 476-9200
(801) 476-9208

Taxonomy

Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
1570611205
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
07051946
OWNERS DOB
Enumeration date
12/02/2011
Last updated
12/02/2011
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