Provider Demographics
NPI:1639385438
Name:JOSEPH W VICK ROY JR MD PC
Entity type:Organization
Organization Name:JOSEPH W VICK ROY JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:W
Authorized Official - Last Name:VICKROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-293-6823
Mailing Address - Street 1:2708 GALLIVAN LOOP
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7074
Mailing Address - Country:US
Mailing Address - Phone:801-599-1750
Mailing Address - Fax:801-293-6828
Practice Address - Street 1:1200 E 3900 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1300
Practice Address - Country:US
Practice Address - Phone:801-293-6823
Practice Address - Fax:801-293-6828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT183895-12052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty