LEGACY DERMATOLOGY is a medical specialty clinic center in Bountiful, UT. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). LEGACY DERMATOLOGY NPI is 1376944942. The provider is registered as an organization entity type.
The provider's business location address is:
320 W 500 S
SUITE 210
BOUNTIFUL, UT
ZIP 84010-218
Phone: (385) 312-0650
Fax: (385) 743-3333
The provider's authorized official is Jared Rex Heaton .
The authorized official title is Physician and has the following contact phone number (435) 770-9247.
The CLIA number assigned to this NPI record is 46D2097163 - physician office with a certificate type of Certificate of Compliance.
The enumeration date for this NPI number is 9/14/2014 and was last updated on 9/14/2014.