| NPI | 1922119528 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNETTE DICKAMORE Assistant Office Manager 435-734-2041 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 175715-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 151481-1205) |
| 207Q00000X Family Medicine (Licence: UT 151559-1205) | |
| 207Q00000X Family Medicine (Licence: UT 160903-1205) | |
| 207R00000X Internal Medicine (Licence: UT 163362-1205) | |
| 207R00000X Internal Medicine (Licence: UT 185588-1205) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2009-11-25 |