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>> General Practice >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1598919177

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
Tel: 307-344-7965  Fax: --

Contact information for business:
1180 S 800 E  SALT LAKE CITY, UT 84105-1257 US
Tel: 281-702-3193  Fax: --

Registration Information:
NPI: 1598919177
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y208D00000XAllopathic & Osteopathic Physicians
General Practice

Legacy codes, insurance codes and state license numbers:



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