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General NPI Number Information
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NPI Number | 1174539142
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Entity Type | Organization
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Legal Business Name | BOUNTIFUL FAMILY HEALTHCARE
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 12/31/2021
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Provider Practice Location Address
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Address Line | 65 W 400 N STE 200B
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City | BOUNTIFUL
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State | UT
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Zip | 84010-6475
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Country | US
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Telephone | 801-298-3812
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Fax | 877-450-7813
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Provider Business Mailing Address
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Address Line | 65 W 400 N STE 200B
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City | BOUNTIFUL
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State | UT
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Zip | 84010-6475
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Country | US
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Telephone | 801-298-3812
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Fax | 877-450-7813
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRIAN J RODGERS
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Credential | D.O.
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Telephone | 801-298-3812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 30835038904
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License Number State | UT
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