Healthcare Provider Details

I. General information

NPI: 1790869550
Provider Name (Legal Business Name): DOUGLAS MALCOLM VOGELER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 E SEGO LILY DR STE 100
SANDY UT
84092-4350
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 801-265-2212
  • Fax:
Mailing address:
  • Phone: 702-954-7672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1595481205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: