Provider Demographics
NPI:1417315243
Name:COTTONWOOD OB-GYN
Entity Type:Organization
Organization Name:COTTONWOOD OB-GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:THACKERAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-507-1950
Mailing Address - Street 1:5063 S COTTONWOOD ST STE 400
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6773
Mailing Address - Country:US
Mailing Address - Phone:801-507-1950
Mailing Address - Fax:801-507-1951
Practice Address - Street 1:5063 S COTTONWOOD ST STE 400
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-507-1950
Practice Address - Fax:801-507-1951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty