Registry details
Type
Individual
Primary specialty
Anesthesiology
Enumerated
Apr 5, 2015
License(s)
12208311-1205 (UT), 12208311-1205 (UT)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 30 N 1900 E RM 3C444 | Salt Lake City, UT 84132-0002 | 801-587-1771 |
| MAILING | 30 N 1900 E RM 3C444 | Salt Lake City, UT 84132-0002 | 801-587-1771 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.