Provider Demographics
NPI:1316026057
Name:WILLARD Z MAUGHAN M.D. P.C.
Entity Type:Organization
Organization Name:WILLARD Z MAUGHAN M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLARD
Authorized Official - Middle Name:Z
Authorized Official - Last Name:MAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-475-5210
Mailing Address - Street 1:6028 S RIDGELINE DR
Mailing Address - Street 2:STE 200
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6914
Mailing Address - Country:US
Mailing Address - Phone:801-475-5210
Mailing Address - Fax:801-475-5209
Practice Address - Street 1:6028 S RIDGELINE DR
Practice Address - Street 2:STE 200
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6914
Practice Address - Country:US
Practice Address - Phone:801-475-5210
Practice Address - Fax:801-475-5209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1614591205207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C63921Medicare UPIN
000057444Medicare PIN