Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2026-03-25
- Last updated
- 2026-04-15
Specialties
Licenses
- License UT
- 14280134-9926
Location
- Practice location
- 210 E MAIN ST STE 201
- City
- MIDWAY UT
- Postal code
- 840496817
- Phone
- 435-654-2822
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
Search this city from the state hub for other records in the public registry.
Removal request
Public data from NPPES and CMS. Not a credentialing determination.