is a Diagnostic Radiology in Salt Lake City, Utah. practices all healthcare services and medical treatments related to Diagnostic Radiology. The NPI Number for is 1396796967. The last update date is .
's current location address is Po Box 30077, Salt Lake City, Utah. You can contact this provider via phone number 8772438416. The mailing address for is Po Box 30077, Salt Lake City, Utah. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | Po Box 30077, Salt Lake City, Utah |
| Phone Number | 8772438416 |
| Fax Number | |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1396796967 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | Po Box 30077 |
|---|---|
| City | Salt Lake City |
| State | Utah (UT) |
| Post Code | 841300077 |
| Phone Number | 8772438416 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Diagnostic Radiology |
|---|---|
| Taxonomy | 2085R0202X |
| Licence No | 6852 |
|
Definition: A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| NV4874 | NV | BCBS | |
| 153094 | NV | WC | |
| 153080 | NV | WC | |
| NV2201 | NV | BCBS | |
| 200290113 | NV | -- |
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