Healthcare Provider Details

I. General information

NPI: 1699354639
Provider Name (Legal Business Name): GRACE ISAACSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRACE ISAACSON DO

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 N MAIN ST
BOUNTIFUL UT
84010-6046
US

IV. Provider business mailing address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 801-397-6400
  • Fax:
Mailing address:
  • Phone: 814-375-6560
  • Fax: 814-375-2848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13998700-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: