Healthcare Provider Details

I. General information

NPI: 1467637926
Provider Name (Legal Business Name): OGDEN EAR NOSE & THROAT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E 5350 S SUITE 130
OGDEN UT
84405-6946
US

IV. Provider business mailing address

425 E 5350 S SUITE 130
OGDEN UT
84405-6946
US

V. Phone/Fax

Practice location:
  • Phone: 801-476-0342
  • Fax: 801-476-9088
Mailing address:
  • Phone: 801-476-0342
  • Fax: 801-476-9088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number952927061205
License Number StateUT

VIII. Authorized Official

Name: DR. DOUGLAS KENT ANDERSON
Title or Position: OWNER
Credential: MD
Phone: 801-476-0342