Provider Demographics
NPI:1639652308
Name:GARLING MEDICAL PC
Entity Type:Organization
Organization Name:GARLING MEDICAL PC
Other - Org Name:DERMATOLOGY AFFILIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:GARLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-272-4219
Mailing Address - Street 1:1345 E 3900 S STE 110
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-4403
Mailing Address - Country:US
Mailing Address - Phone:801-272-4219
Mailing Address - Fax:810-272-8565
Practice Address - Street 1:1345 E 3900 S STE 110
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-4403
Practice Address - Country:US
Practice Address - Phone:801-272-4219
Practice Address - Fax:810-272-8565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT81643911206207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1306982855Medicaid