Provider Demographics
NPI:1780606731
Name:HEYWOOD, SAMUEL GREG (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:GREG
Last Name:HEYWOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 W 400 N STE C
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-1950
Mailing Address - Country:US
Mailing Address - Phone:304-345-4525
Mailing Address - Fax:304-345-4527
Practice Address - Street 1:505 W 400 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-1950
Practice Address - Country:US
Practice Address - Phone:801-714-3422
Practice Address - Fax:801-714-3424
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20012207V00000X
UT11283381-1205207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV550691297OtherCIGNA
WV550691297OtherSELECT NET
WV001717320OtherBLUE CROSS
WV550691297OtherCARELINK
WV550691297OtherUNICARE
WV7672206OtherAETNA
WV245048OtherMAMSI UNITED HEALTH CARE
WV550691297OtherTRICARE
WV1802068000Medicaid
WV550691297Other4 MOST
WV550691297OtherCIGNA
WV550691297OtherCARELINK
WV001717320OtherBLUE CROSS
WV2031733Medicare PIN
WV550691297OtherUNICARE
H21792Medicare UPIN
WV2031735Medicare PIN
WV2031737Medicare PIN
WV2031736Medicare PIN
WV2031732Medicare PIN