Provider Demographics
NPI:1851705578
Name:WASATCH FOOT AND ANKLE SPECIALISTS, LLC
Entity type:Organization
Organization Name:WASATCH FOOT AND ANKLE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:FREDERIC
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-505-0820
Mailing Address - Street 1:440 MEDICAL DR
Mailing Address - Street 2:SUITE #2
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4950
Mailing Address - Country:US
Mailing Address - Phone:801-298-1160
Mailing Address - Fax:
Practice Address - Street 1:440 MEDICAL DR
Practice Address - Street 2:SUITE #2
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4950
Practice Address - Country:US
Practice Address - Phone:801-298-1160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT89263210501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty