Basic Information
| Provider Information | |||||||||
| NPI: | 1457427395 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WARDEN | ||||||||
| FirstName: | GLENN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5470 PIONEER FORK RD | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841081674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017463977 | ||||||||
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| Practice Location | |||||||||
| Address1: | SHRINER HOSPITAL FOR CHILDREN | ||||||||
| Address2: | 1340 E. 300 N. | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841034399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015363600 | ||||||||
| FaxNumber: | 8015363868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2006 | ||||||||
| LastUpdateDate: | 01/22/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 151542-1205 | UT | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.