NPI 1346410073

Wasatch Neurological Surgery PC

Organisation Specialist Bountiful, UT

Practice location

Address: 3401 S Highway 89, Bountiful, UT 84010-8517
Phone: (801) 295-2438
Fax: (866) 630-0782

Authorised official

Name: Brent Lee Clyde
Title: Owner
Phone: (801) 295-2438

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X Licence 48219121205 (UT)

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Registry record

NPI: 1346410073
Entity type: Organization
NPI issued: 10 Mar 2008
Record last updated: 1 May 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.