Healthcare Provider Details

I. General information

NPI: 1508073743
Provider Name (Legal Business Name): HAROLD N GOOCH MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12176 S 1000 E
DRAPER UT
84020-9716
US

IV. Provider business mailing address

PO BOX 150610
OGDEN UT
84415-0610
US

V. Phone/Fax

Practice location:
  • Phone: 801-572-3750
  • Fax: 801-572-1097
Mailing address:
  • Phone: 801-476-9200
  • Fax: 801-476-9208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number181191-1205
License Number StateUT

VIII. Authorized Official

Name: BEN GUNN
Title or Position: OFFICE MANAGER
Credential:
Phone: 801-572-3750