Provider Demographics
NPI:1689684672
Name:UTAH ADVANCED LAPAROSCOPY INC.
Entity Type:Organization
Organization Name:UTAH ADVANCED LAPAROSCOPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:PEUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-772-1972
Mailing Address - Street 1:1159 E 200 N
Mailing Address - Street 2:SUITE 350
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2022
Mailing Address - Country:US
Mailing Address - Phone:801-772-1975
Mailing Address - Fax:801-756-5091
Practice Address - Street 1:1159 E 200 N
Practice Address - Street 2:SUITE 350
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2022
Practice Address - Country:US
Practice Address - Phone:801-772-1975
Practice Address - Fax:801-756-5091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT51150451205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty