Provider Demographics
NPI:1316366131
Name:SANDRA WHITFIELD M.D.
Entity Type:Organization
Organization Name:SANDRA WHITFIELD M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-391-7410
Mailing Address - Street 1:5998 S 2950 E
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-5476
Mailing Address - Country:US
Mailing Address - Phone:801-391-7410
Mailing Address - Fax:180-175-2193
Practice Address - Street 1:5998 S 2950 E
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-5476
Practice Address - Country:US
Practice Address - Phone:801-391-7410
Practice Address - Fax:180-175-2193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT162621-1205261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center