Provider Demographics
NPI:1457470585
Name:WOSETH DERMATOLOGY, P.C.
Entity Type:Organization
Organization Name:WOSETH DERMATOLOGY, P.C.
Other - Org Name:LEONARD J.SWINYER, M.D., P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOSETH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-266-8841
Mailing Address - Street 1:3920 SOUTH 1100 EAST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1276
Mailing Address - Country:US
Mailing Address - Phone:801-266-8841
Mailing Address - Fax:801-266-0449
Practice Address - Street 1:3920 SOUTH 1100 EAST
Practice Address - Street 2:SUITE 310
Practice Address - City:SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84124-1276
Practice Address - Country:US
Practice Address - Phone:801-266-8841
Practice Address - Fax:801-266-0449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT61442381205174400000X
UT6144238-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000057089Medicare PIN