Edward G Southwick, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

156560-1205 Issued in UT

Practice address

3465 S 4155 W
Suite #1
West Valley City, UT 84120-2076

Phone

(801) 966-1403

Fax

(801) 964-6478

NPI assigned

Jan 19, 2006

Last updated

Aug 14, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Edward G. Southwick, M.D., P.C.

  • Specialist
  • West Valley City, UT
  • NPI 1215287503
  Authorized official Same address or phone

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344902400000",
    "number": "1619957156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3465 SOUTH 4155 WEST",
            "address_2": "SUITE #1",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841202077",
            "telephone_number": "801-966-1403",
            "fax_number": "801-964-6478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3465 S 4155 W",
            "address_2": "SUITE #1",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841202076",
            "telephone_number": "801-966-1403",
            "fax_number": "801-964-6478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHWICK",
        "first_name": "EDWARD",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2012-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "UT",
            "license": "156560-1205",
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "UT",
            "license": "156560-1205",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "UT",
            "license": "156560-1205",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "071157009",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nichole Sorensen
• Samantha Alexis Sorensen, LCSW
• Shala Sorensen
• Steven Sorensen
• Julie Sotelo
• Michelle Denae Speckman, RPH
• Elizabeth Spencer
• Spine & Sports Medicine
• Spine and Sports Medicine Inc
• Warren R Stack, MD

• Dermatology Physician in West Valley City, UT
• Providers in West Valley City, UT by specialty
• Dermatology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2012; 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.