Provider Demographics
NPI:1891176939
Name:WASATCH DERMATOLOGY, PC
Entity Type:Organization
Organization Name:WASATCH DERMATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-475-5210
Mailing Address - Street 1:5734 S 1475 E
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4596
Mailing Address - Country:US
Mailing Address - Phone:801-475-5210
Mailing Address - Fax:801-475-5209
Practice Address - Street 1:5734 S 1475 E
Practice Address - Street 2:SUITE 300
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4596
Practice Address - Country:US
Practice Address - Phone:801-475-5210
Practice Address - Fax:801-475-5209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT53377011205207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty