Provider Demographics
NPI:1063513596
Name:MAVES, CONSTANCE K (MD)
Entity type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:K
Last Name:MAVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:869 E 4500 S
Mailing Address - Street 2:PMB 511
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3049
Mailing Address - Country:US
Mailing Address - Phone:801-487-0451
Mailing Address - Fax:801-487-2467
Practice Address - Street 1:100 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-662-1900
Practice Address - Fax:801-662-1810
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT5010881-12052085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1070011544101OtherSELECTHEALTH
UT1600468OtherUNITED HEALTHCARE
UT50108811200001OtherBLUE SHIELD
UT67154OtherPUBLIC EMPLOYEES HEALTH
UT870355724MAVOtherEDUCATORS MUTUAL
UT8550895OtherAETNA
UT31853OtherUUHN
UT35834OtherDESERET MUTUAL
UTQM0000027099OtherALTIUS
UTQM0000027099OtherALTIUS
UT67154OtherPUBLIC EMPLOYEES HEALTH