Individual
MATTHEW POULSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
700 W 800 N, SUITE 100, OREM, UT 84057-6301
(801) 224-5373
(801) 224-5337
Mailing address
1055 N 500 W, PROVO, UT 84604-3305
(801) 354-8225
(801) 429-8150
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
43447
KY
207X00000X
Orthopaedic Surgery Physician
Primary
4725374-1205
UT
Other
Enumeration date
06/09/2006
Last updated
09/07/2012
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