Provider Demographics
NPI:1538396957
Name:JOE EYRING MD PC
Entity type:Organization
Organization Name:JOE EYRING MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:EYRING
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:801-265-3978
Mailing Address - Street 1:348 E 4500 S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3906
Mailing Address - Country:US
Mailing Address - Phone:801-265-9378
Mailing Address - Fax:801-265-3988
Practice Address - Street 1:348 E 4500 S
Practice Address - Street 2:SUITE 200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-3906
Practice Address - Country:US
Practice Address - Phone:801-265-9378
Practice Address - Fax:801-265-3988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3138271205208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty