Provider Demographics
NPI:1518115419
Name:REED FOGG MD PC
Entity Type:Organization
Organization Name:REED FOGG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REED
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-314-2225
Mailing Address - Street 1:5770 SO 250 E
Mailing Address - Street 2:SUITE 135
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-8241
Mailing Address - Country:US
Mailing Address - Phone:801-314-2225
Mailing Address - Fax:801-314-2345
Practice Address - Street 1:5770 SO 250 E
Practice Address - Street 2:SUITE 135
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8241
Practice Address - Country:US
Practice Address - Phone:801-314-2225
Practice Address - Fax:801-314-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT147576-1205207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTC63681Medicare UPIN