Healthcare Provider Details

I. General information

NPI: 1659313583
Provider Name (Legal Business Name): DOUGLAS SPENCE KASTELER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 S 400 E STE 100
BOUNTIFUL UT
84010-4862
US

IV. Provider business mailing address

PO BOX 5546
DENVER CO
80217-5546
US

V. Phone/Fax

Practice location:
  • Phone: 801-397-6200
  • Fax: 801-397-6201
Mailing address:
  • Phone: 801-475-3500
  • Fax: 801-475-3489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1843601205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: