Provider Demographics
NPI:1538267877
Name:MIDDLETON UROLOGICAL ASSOCIATES
Entity type:Organization
Organization Name:MIDDLETON UROLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-266-8664
Mailing Address - Street 1:1060 E 100 S
Mailing Address - Street 2:#110
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1501
Mailing Address - Country:US
Mailing Address - Phone:801-531-9453
Mailing Address - Fax:801-531-9467
Practice Address - Street 1:1060 E 100 S
Practice Address - Street 2:#110
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1501
Practice Address - Country:US
Practice Address - Phone:801-531-9453
Practice Address - Fax:801-531-9467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055097Medicare ID - Type UnspecifiedGROUP #