Individual
SAMANTHA P BOSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1477 NORTH 2000 WEST, SUITE C, CLINTON, UT 84015-8213
(801) 774-8888
(801) 825-8519
Mailing address
1477 NORTH 2000 WEST, SUITE C, CLINTON, UT 84015-8213
(801) 774-8888
(801) 825-8519
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
327457-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D2612
—
UT
Enumeration date
05/16/2007
Last updated
08/12/2015
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