Wasatch Neurological Surgery PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

48219121205 Issued in UT

Legal business name

WASATCH NEUROLOGICAL SURGERY PC

Practice address

3401 S Highway 89
Bountiful, UT 84010-8517

Phone

(801) 295-2438

Fax

(866) 630-0782

NPI assigned

Mar 10, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Brent Lee Clyde, M.D.

Title

Owner

Phone

(801) 295-2438

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209600000000",
    "number": "1346410073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 S HIGHWAY 89",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840108517",
            "telephone_number": "801-295-2438",
            "fax_number": "866-630-0782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 S HIGHWAY 89",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840108517",
            "telephone_number": "801-295-2438",
            "fax_number": "866-630-0782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASATCH NEUROLOGICAL SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-10",
        "last_updated": "2008-05-01",
        "status": "A",
        "authorized_official_last_name": "CLYDE",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-295-2438",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "UT",
            "license": "48219121205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Carl Warren, PT
• Steven Edward Warren, MD DPA
• Clara Leah Warrick
• Wasatch Endodontics, PC
• Wasatch Foot and Ankle Specialists, LLC
• Wasatch Rehab Inc
• Wasatch Surgical LLC
• Zetyra Washington
• John Orville Waterbury, LPC
• Courtney Waters

• Specialist in Bountiful, UT
• Providers in Bountiful, UT by specialty
• Specialist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.