Provider Demographics
NPI:1356746168
Name:WASATCH FOOT AND ANKLE SPECIALISTS LLC
Entity type:Organization
Organization Name:WASATCH FOOT AND ANKLE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:FREDERIC
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-505-0820
Mailing Address - Street 1:700 W 800 N
Mailing Address - Street 2:STE 330
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-6301
Mailing Address - Country:US
Mailing Address - Phone:801-426-3686
Mailing Address - Fax:801-426-3689
Practice Address - Street 1:700 W 800 N
Practice Address - Street 2:STE 330
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-6301
Practice Address - Country:US
Practice Address - Phone:801-426-3686
Practice Address - Fax:801-426-3689
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASATCH FOOT AND ANKLE SPECIALISTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9008591-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty