| Identity Hormones Ut Llc | |
|
1327 E 2100 S Ste 101 Salt Lake City UT 84105-3763 | |
| (602) 354-3925 | |
| Not Available |
| Full Name | Identity Hormones Ut Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1327 E 2100 S Ste 101, Salt Lake City, Utah |
| Authorized Official Name and Position | Teah Smith (CREDENTIALING MANAGER) |
| Authorized Official Contact | 9012053999 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Identity Hormones Ut Llc 1327 E 2100 S Ste 101 Salt Lake City UT 84105-3763 Ph: () - | Identity Hormones Ut Llc 1327 E 2100 S Ste 101 Salt Lake City UT 84105-3763 Ph: (602) 354-3925 |
| NPI Number | 1669104402 |
|---|---|
| Provider Enumeration Date | 06/29/2022 |
| Last Update Date | 11/13/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669104402 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
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