Provider Demographics
NPI:1720316714
Name:POFF, EMILY SPENCER (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:SPENCER
Last Name:POFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:48 WEST 1500 NORTH
Mailing Address - Street 2:
Mailing Address - City:NEPHI
Mailing Address - State:UT
Mailing Address - Zip Code:84648
Mailing Address - Country:US
Mailing Address - Phone:801-391-6497
Mailing Address - Fax:
Practice Address - Street 1:48 WEST 1500 NORTH
Practice Address - Street 2:
Practice Address - City:NEPHI
Practice Address - State:UT
Practice Address - Zip Code:84648
Practice Address - Country:US
Practice Address - Phone:435-623-3200
Practice Address - Fax:435-623-3265
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7730025-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1720316714Medicaid
UTU000072192Medicare PIN