Provider Demographics
NPI:1598826422
Name:FOTHERINGHAM, BART W (MD)
Entity Type:Individual
Prefix:
First Name:BART
Middle Name:W
Last Name:FOTHERINGHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 SO 300 EAST
Mailing Address - Street 2:SUITE #300
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107
Mailing Address - Country:US
Mailing Address - Phone:801-314-2308
Mailing Address - Fax:801-314-2413
Practice Address - Street 1:5810 SO 300 EAST
Practice Address - Street 2:SUITE #300
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-314-2308
Practice Address - Fax:801-314-2413
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1877101205208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation