U-U Pediatric Dermatology
Organization Active NPI Pediatric Dermatology Physician · Salt Lake City, UT
NPI 1235339193 · NPPES record last updated Mar 4, 2025
Key facts
- NPI
- 1235339193
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatric Dermatology Physician 207NP0225X
- License
- 2752851205 (UT)
- Legal business name
- U-U PEDIATRIC DERMATOLOGY
- Practice address
- 100 N Medical Dr
Salt Lake City, UT 84113-1103 - Phone
- (801) 587-6340
- Fax
- (801) 587-6346
- NPI assigned
- Jul 19, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Kristina Callis Duffin, MD
- Title
- Chief Clinical Officer
- Phone
- (801) 587-6336
Practitioners 139
-
Jonathan Ashton Olsen, D.O.
-
Doerthe Adriana Andreae, M.D.
-
Brooks Bahr, M.D.
-
Spencer Bertoch, M.D.
-
Anneli R Bowen, M.D.
-
Elise Sylvie Burger, MD, PHD
-
Margaret Maria Cocks, M.D.
-
Dekker Deacon, M.D., PH.D.
-
Keith Duffy, M.D.
-
Christopher M Hull, M.D.
-
Christopher Jessen, DNP
-
Luke S Johnson, MD
-
Sancy A Leachman, M.D.
-
Bethany Kirk Helms Lewis, M.D., M.P.H
-
Nisma Mujahid, MD, PHD
-
Marta J Petersen, M.D.
-
Megan Prouty, MD
-
Aaron Michael Secrest, MD, PHD
-
Robert Sylvester, CPNP-PC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041020000616 | UT | Part B Supplier - Clinic/Group Practice | 8729049002 |
Receives reassigned benefits from 45 practitioners Practice locations: Salt Lake City, UT |
National Provider Directory
Locations
30 N 1900 E
Rm 4A330
Salt Lake City, UT 84132
Phone (801) 581-5509
417 S Wakara Way
Salt Lake City, UT 84108
Phone (801) 581-3506
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dermatology Physician |
207NP0225X | 2752851205 | UT | Yes |
Addresses
Primary practice location
100 N Medical Dr
Salt Lake City, UT 84113-1103
Mailing address
PO Box 841052
Los Angeles, CA 90084-1450
Phone (801) 587-6340
Other providers in Salt Lake City, UT
- U-U Gastroenterology Division
- U-U Hematology-Oncology Division
- U-U Human Development Division
- U-U Infectious Disease Division
- U-U Noninvasive Vascular Lab
- U-U Pulmonary Division
- U-U Rehabilitation Medicine
- U-U Rheumatology Division
- Ucfa Physicians Network Group of Ut
- Derek Akio Uchida
All providers in Salt Lake City, UT · Pediatric Dermatology Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 4, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.