Basic Information
| Provider Information | |||||||||
| NPI: | 1558771436 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WAIT | ||||||||
| FirstName: | ERIC | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 590 S WAKARA WAY | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841081200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015875400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 590 S WAKARA WAY | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841081200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015875400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2014 | ||||||||
| LastUpdateDate: | 06/12/2019 | ||||||||
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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 | 207X00000X | BP10049573 | TX | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XP3100X | 11268149-1205 | UT | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Pediatric Orthopaedic Surgery |
No ID Information.