Provider Demographics
NPI:1013915867
Name:EYRE DERMATOLOGY CLINIC, P.C.
Entity Type:Organization
Organization Name:EYRE DERMATOLOGY CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:EYRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-431-0300
Mailing Address - Street 1:486 W 800 N
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-3728
Mailing Address - Country:US
Mailing Address - Phone:801-431-0300
Mailing Address - Fax:801-431-0312
Practice Address - Street 1:486 W 800 N
Practice Address - Street 2:SUITE 201
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-3728
Practice Address - Country:US
Practice Address - Phone:801-431-0300
Practice Address - Fax:801-431-0312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1088470-0144174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty