Healthcare Provider Details

I. General information

NPI: 1700883600
Provider Name (Legal Business Name): RANDALL DEAN BARNETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5405 S 500 E SUITE 101
OGDEN UT
84405-6957
US

IV. Provider business mailing address

5405 S 500 E SUITE 101
OGDEN UT
84405-6957
US

V. Phone/Fax

Practice location:
  • Phone: 801-689-3500
  • Fax: 801-689-3505
Mailing address:
  • Phone: 801-689-3500
  • Fax: 801-689-3505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number94-272450-1250
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: