DR. CORY B MAUGHAN (NPI# 1598086720) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598086720 |
| Entity Type | Individual |
| Full Name | DR. CORY B MAUGHAN |
| Credential | D.O. |
| Practice Address |
169 N Gateway Dr Ste 100 Providence UT 84332 |
| Mailing Address |
540 S 800 E River Heights UT 84321-5600 |
| Practice Telephone | 5419994475 |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2019-05-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | DO155462 | OR | Allopathic & Osteopathic Physicians |
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
9869105-1204 | UT | Allopathic & Osteopathic Physicians |
| N | 208D00000X | General Practice | PG151474 | OR | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1760 N 200 E, Ste 101, North Logan, UT 84341 | 4357870560 | |
| 434 E 5350 S Ste D, Ogden, UT 844055417 | 8018279100 | 8018279110 |
| Street Address |
169 N GATEWAY DR STE 100 |
| City | PROVIDENCE |
| State | UT |
| Zip Code | 84332 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568029957 | Cbm Derm LLC | Dermatology | 169 N Gateway Dr Ste 100, Providence, UT 84332-9860 | 2019-05-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881292167 | 3bc Incorporated | Pharmacy | 435 North Gateway Drive #802, Providence, UT 84332 | 2020-10-09 |
| 1962049932 | Wholelife Family Wellness Clinic of Providence Pllc | Counselor | 169 N Gateway Dr. Suite 170, Providence, UT 84332 | 2019-12-09 |
| 1033503420 | Spring Creek Surgical Center, LLC | Clinic/Center | 65 North Gateway Drive, Suite 3, Providence, UT 84332 | 2015-03-24 |
| 1558751438 | Naturopathic Medical, P.C. | Naturopath | 565 W. 465 N., Suite 150, Providence, UT 84332 | 2015-01-29 |
| 1821421710 | Erin Campbell | Physical Therapist | 267 West Spring Creek Parkway, Providence, UT 84332 | 2013-08-14 |
| 1285981530 | Jordan Joseph Hansen | Dentist | 169 N Gateway Drive, Suite 200, Providence, UT 84332 | 2012-08-06 |
| 1528299245 | South Valley Eyecare Center, Inc. | Optometrist | 276 Springcreek Pkwy, Providence, UT 84332 | 2009-07-29 |
| 1316134356 | Heather Saxton Maughan | Speech-Language Pathologist | 344 E Edgehill Dr, Providence, UT 84332 | 2007-10-03 |
| 1902021538 | Brad L Thomas | Physical Therapist | 169 Spring Creek Park Way, Suite 140, Providnce, UT 84332 | 2007-04-17 |
| 1558495457 | Maceys Inc | Pharmacy | 50 North Highway 165, Providence, UT 84332 | 2007-03-15 |
| Find all providers in zip 84332 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730538026 | Brown Dermatology, Inc. | Dermatology | 593 Eddy St, Apc-10, Providence, RI 02903-4923 | 2016-06-07 |
| 1770770547 | Surgical & Cosmetic Dermatology of Rhode Island, LLC | Dermatology | 1 Randall Sq, Suite 306, Providence, RI 02904-2709 | 2007-09-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053823120 | Fife Dermatology Utah | Dermatology | 1490 E Foremaster Drive, Suite 260, St.george, UT 84790-4488 | 2017-10-30 |
| 1710242235 | Breton Adam Orel Yates | Dermatology | 1548 E 4500 S, Ste 202, Salt Lake City, UT 84117-5209 | 2012-07-10 |
| 1902171895 | M R Hinckley Md Pllc | Dermatology | 602 Fort Union Blvd, 2nd Floor, Midvale, UT 84047-2216 | 2012-03-12 |
| 1508826587 | John S Blake | Dermatology | 210 W 300 N 7-3, Roosevelt, UT 84066 | 2006-03-24 |
| City | PROVIDENCE |
| Zip Code | 84332 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.