| NPI | 1780429167 |
|---|---|
| Doing Business As | BONNEY LAKE MEDICAL |
| Entity Type | Organization |
| Authorized Contact | JOSH LEDER CEO 801-641-5613 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2024-06-27 |
| Last Update Date | 2024-06-27 |