Healthcare Provider Details

I. General information

NPI: 1093850885
Provider Name (Legal Business Name): CANCER AND BLOOD INSTITUTE OF SOUTHERN UTAH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 S 400 E
SAINT GEORGE UT
84770-3705
US

IV. Provider business mailing address

544 S 400 E
SAINT GEORGE UT
84770-3705
US

V. Phone/Fax

Practice location:
  • Phone: 435-986-9369
  • Fax: 435-986-9368
Mailing address:
  • Phone: 435-986-9369
  • Fax: 435-986-9368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number6079303-1205
License Number StateUT

VIII. Authorized Official

Name: DON LYNN DAVIS
Title or Position: PRESIDENT
Credential:
Phone: 435-986-9369