Provider Demographics
NPI:1376641456
Name:MOENCH, MATTHEW LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LOUIS
Last Name:MOENCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:525 E 100 S STE 5000
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1992
Mailing Address - Country:US
Mailing Address - Phone:801-585-1212
Mailing Address - Fax:801-585-9096
Practice Address - Street 1:525 E 100 S STE 5000
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1992
Practice Address - Country:US
Practice Address - Phone:801-585-1212
Practice Address - Fax:801-585-9096
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT616687889052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry