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NPI Code Detail

MEDICARE: KHALDOUN M AL-RAYESS MD

MEDICARE: KHALDOUN M AL-RAYESS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RE0101XEndocrinology, Diabetes & Metabolism Physician5804089UT
2207RE0101XEndocrinology, Diabetes & Metabolism Physician5804089-1205UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000G57660OTHERGROUP

General Provider Information

NPI Number : 1003808122
Entity Type Code : Individual
Provider Name (Legal Business Name) : KHALDOUN M AL-RAYESS MD
Provider Business Mailing Address
First Line : PO BOX 337
Second Line :
City : LAYTON
State : UT
Zip : 84041-0337
Country : US
Telephone Number : 801-773-4840
Fax Number : 801-525-8151
Provider Business Practice Location Address
First Line : 2121 N 1700 W
Second Line :
City : LAYTON
State : UT
Zip : 84041-8803
Country : US
Telephone Number : 801-773-4840
Fax Number : 801-525-8151
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2005
Last Update Date : 12/16/2019

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Directions to “ KHALDOUN M AL-RAYESS MD” Practice Location

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