Provider Demographics
NPI:1437433422
Name:SALT LAKE PODIATRY CENTER PLLC
Entity Type:Organization
Organization Name:SALT LAKE PODIATRY CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PREECE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:801-231-7410
Mailing Address - Street 1:144 S 700 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1109
Mailing Address - Country:US
Mailing Address - Phone:801-532-1822
Mailing Address - Fax:
Practice Address - Street 1:144 S 700 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1109
Practice Address - Country:US
Practice Address - Phone:801-532-1822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-08
Last Update Date:2011-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTFP2145755213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty