Dr. Edward G Southwick
Dermatologist Dermatopathologist Procedural Dermatology
3465 S 4155 W Suite #1
West Valley City
, Utah 84120-2076
Dr. Edward G Southwick
Dermatologist Dermatopathologist Procedural Dermatology
3465 S 4155 W Suite #1
West Valley City
, Utah 84120-2076
(801) 964-6478
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About
Features
Specialties
- Dermatologist
- Dermatopathologist
- Procedural Dermatology
Languages spoken
- English
Location
First Address
- Dr. Edward G Southwick
- 3465 South 4155 West Suite #1
- West Valley City, UT
- Zip : 84120-2077
- Fax : (801) 964-6478
- Phone : (801) 966-1403
Second Address
- Dr. Edward G Southwick
- 3465 S 4155 W Suite #1
- West Valley City, UT
- Zip : 84120-2076
- Fax : (801) 964-6478
- Phone : (801) 966-1403
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207N00000X | Dermatologist | 156560-1205 | UT |
| N | 207ND0900X | Dermatopathologist | 156560-1205 | UT |
| N | 207NS0135X | Procedural Dermatology | 156560-1205 | UT |
National Provider Identifier
| NPI | 1619957156 |
|---|---|
| Provider Name | Dr. Edward G Southwick |
| First Address | West Valley City, UT 84120-2077 |
| Second Address | West Valley City, UT 84120-2076 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 19/01/2006 |
| Last Update Date | 14/08/2012 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 071157009 | RAILROAD MEDICARE (01) | UT |
| C63377 | (02) | UT |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.