Provider Demographics
NPI:1083717276
Name:ENGSTROM, FAE L (MD)
Entity Type:Individual
Prefix:
First Name:FAE
Middle Name:L
Last Name:ENGSTROM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
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Mailing Address - Street 1:3340 NORTH CENTER ST
Mailing Address - Street 2:#800
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:3741 W 12600 S
Practice Address - Street 2:RIVERTON HOSPITAL
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065
Practice Address - Country:US
Practice Address - Phone:801-285-4000
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT180467-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTPRA06915OtherMOLINA
WY118944100Medicaid
UT2090168OtherUNITED HEALTHCARE
UT73552OtherPEHP
ID003680100Medicaid
UT18959OtherDESERET MUTUAL
UT107005343102OtherIHC
AZ823626Medicaid
UT870545614EN2OtherTRICARE
UT100890OtherHEALTHY U
UT870545614EN2OtherEDUCATORS MUTUAL
NV100501859Medicaid
UT1502954OtherUMWA
UTQM0000075886OtherALTIUS
UT1502954OtherUMWA
UT2090168OtherUNITED HEALTHCARE
UTP00031116Medicare ID - Type UnspecifiedRAILROAD MEDICARE