Healthcare Provider Details

I. General information

NPI: 1376613141
Provider Name (Legal Business Name): RICHARD CHARLES ARBOGAST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 W 3300S
OGDEN UT
84401
US

IV. Provider business mailing address

2240 ADAMS AVE
OGDEN UT
84401-1511
US

V. Phone/Fax

Practice location:
  • Phone: 801-393-5355
  • Fax: 801-394-4609
Mailing address:
  • Phone: 801-393-5355
  • Fax: 801-394-4609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1634071205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1634071205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: