Healthcare Provider Details

I. General information

NPI: 1982141008
Provider Name (Legal Business Name): DOUGLAS KEHL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 W SOUTH LINKS DR
WASHINGTON UT
84780-8524
US

IV. Provider business mailing address

825 W SOUTH LINKS DR
WASHINGTON UT
84780-8524
US

V. Phone/Fax

Practice location:
  • Phone: 435-652-6064
  • Fax:
Mailing address:
  • Phone: 435-652-6064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number9763983-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: