| NPI | 1790149219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAILEE GORES Provider Relations 801-352-9500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 327162-1205) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2016-08-29 |