Provider Demographics
NPI:1841618444
Name:INNES, ERIC WESTON (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:WESTON
Last Name:INNES
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 1:1055 N 500 W
Mailing Address - Street 2:ATTN CREDENTIALING
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-2501
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-581-4367
Practice Address - Street 1:700 W 800 N
Practice Address - Street 2:STE 100
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057
Practice Address - Country:US
Practice Address - Phone:801-373-7350
Practice Address - Fax:801-224-5337
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9538408-1205207L00000X, 207LP2900X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program