Basic Information
| Provider Information | |||||||||
| NPI: | 1124747563 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UTAH BONE AND JOINT SPECIALISTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6360 S 3000 E STE 210 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841216972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356158822 | ||||||||
| FaxNumber: | 4356158823 | ||||||||
| Practice Location | |||||||||
| Address1: | 6360 S 3000 E STE 210 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841216972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356158822 | ||||||||
| FaxNumber: | 4356158823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2022 | ||||||||
| LastUpdateDate: | 08/26/2022 | ||||||||
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| AuthorizedOfficialLastName: | GIBBS | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4356158822 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 213E00000X | N | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.