Healthcare Provider Details

I. General information

NPI: 1174510044
Provider Name (Legal Business Name): DON PRESTON ALLRED DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 09/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1756 PARK AVE
RIVERTON UT
84065-4701
US

IV. Provider business mailing address

1756 PARK AVE
RIVERTON UT
84065-4701
US

V. Phone/Fax

Practice location:
  • Phone: 801-254-0309
  • Fax: 801-254-1012
Mailing address:
  • Phone: 801-254-0309
  • Fax: 801-254-1012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number180302-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: