Registry details
Type
Individual
Primary specialty
Internal Medicine, Cardiovascular Disease
Enumerated
Sep 14, 2005
License(s)
324188-1205 (UT)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 5405 S 500 E SUITE #204 | Ogden, UT 84405-6957 | 801-479-0194 |
| MAILING | PO BOX 741729 | Atlanta, GA 30374-1729 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.