Healthcare Provider Details

I. General information

NPI: 1114111069
Provider Name (Legal Business Name): TRACY KVARFORDT MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S 300 E STE 205
SAINT GEORGE UT
84770-3979
US

IV. Provider business mailing address

515 S 300 E STE 205
SAINT GEORGE UT
84770-3979
US

V. Phone/Fax

Practice location:
  • Phone: 435-674-0999
  • Fax: 435-674-0960
Mailing address:
  • Phone: 435-674-0999
  • Fax: 435-674-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number611694-1205
License Number StateUT

VIII. Authorized Official

Name: DR. TRACY DEE KVARFORDT
Title or Position: PRESIDENT
Credential: MD
Phone: 435-674-0999