Provider Demographics
NPI:1245464858
Name:PHYSICIAN WOUND CARE SPECIALISTS OF UTAH
Entity type:Organization
Organization Name:PHYSICIAN WOUND CARE SPECIALISTS OF UTAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:801-590-9064
Mailing Address - Street 1:6508 S CANYON COVE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6339
Mailing Address - Country:US
Mailing Address - Phone:801-349-5711
Mailing Address - Fax:801-278-9182
Practice Address - Street 1:1220 E 3900 S STE 3A
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1326
Practice Address - Country:US
Practice Address - Phone:801-590-9064
Practice Address - Fax:801-278-9182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FB0623810OtherDEA NUMBER
FB0623810OtherDEA NUMBER