Healthcare Provider Details

I. General information

NPI: 1013527399
Provider Name (Legal Business Name): HEBER VALLEY INTERNAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 E 1500 S STE 201
HEBER CITY UT
84032-3942
US

IV. Provider business mailing address

160 W CANYON CREST RD
ALPINE UT
84004-1679
US

V. Phone/Fax

Practice location:
  • Phone: 435-657-0101
  • Fax: 435-315-3146
Mailing address:
  • Phone: 435-657-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ISAAC BUTTON
Title or Position: MANAGER
Credential:
Phone: 435-657-0101