Organization · Type 2 NPI

Utah Podiatry Group LLC

Foot & Ankle Surgery Podiatrist · Park City, UT

NPI number 1205569100 Active

Practice location

1840 Sun Peak Dr
Park City, UT 84098-6732

Call (801) 505-5277 Map

Fax (801) 505-5280

Mailing address

PO Box 849795
Los Angeles, CA 90084-9795

Specialties and licenses

Taxonomy	Code	License
Podiatrist	213E00000X	None listed
Foot & Ankle Surgery Podiatrist Primary	213ES0103X	None listed
Durable Medical Equipment & Medical Supplies	332B00000X	None listed

Foot & Ankle Surgery Podiatrist: Definition to come...

Another provider at this address

Kent Max Johnson, DDSGeneral Practice Dentistry Park City, UT NPI 1679662837

Other foot & ankle surgery podiatrist providers in Park City

Utah Podiatry Group PCFoot & Ankle Surgery Podiatrist Park City, UT NPI 1679007819

See all in Park City →

NPI record

NPI: 1205569100
Entity type: Organization (Type 2)
Issued: Jul 7, 2022
Last updated: Oct 27, 2025
Status: Active
Subpart: Yes of Utah Podiatry Group LLC

Other names

<unavail>
Advanced Foot and Ankle Center · former legal business name
Advanced Foot and Ankle Center · former legal business name

Authorized official

Scott A Clark
DPM
(801) 505-5277

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1205569100

Utah Podiatry Group LLC's National Provider Identifier is 1205569100, issued on Jul 7, 2022. The primary taxonomy on file is Foot & Ankle Surgery Podiatrist (213ES0103X), and the practice location is in Park City, UT. The record was last updated on Oct 27, 2025.