Healthcare Provider Details

I. General information

NPI: 1184263592
Provider Name (Legal Business Name): MARC RAYMOND HUFNAGEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 W WINCHESTER ST
MURRAY UT
84107-7237
US

IV. Provider business mailing address

9045 S 1300 E
SANDY UT
84094-3134
US

V. Phone/Fax

Practice location:
  • Phone: 801-904-3826
  • Fax:
Mailing address:
  • Phone: 801-666-6834
  • Fax: 801-904-0272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: