1457470585 NPI number — WOSETH DERMATOLOGY, P.C.

Table of content: (NPI 1457470585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457470585 NPI number — WOSETH DERMATOLOGY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOSETH DERMATOLOGY, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LEONARD J.SWINYER, M.D., P.C.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457470585
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3920 SOUTH 1100 EAST
Provider Second Line Business Mailing Address:
SUITE 310
Provider Business Mailing Address City Name:
SALT LAKE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84124-1276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-266-8841
Provider Business Mailing Address Fax Number:
801-266-0449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3920 SOUTH 1100 EAST
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
SALT LAKE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84124-1276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-266-8841
Provider Business Practice Location Address Fax Number:
801-266-0449
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WOSETH
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
M.D.
Authorized Official Telephone Number:
801-266-8841

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  61442381205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 6144238-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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