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General NPI Number Information
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NPI Number | 1174707517
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Entity Type | Organization
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Legal Business Name | SOUTHWEST FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 12/20/2007
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Last Update Date | 10/01/2008
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Provider Practice Location Address
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Address Line | 1575 W 7000 S
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City | WEST JORDAN
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State | UT
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Zip | 84084-3431
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Country | US
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Telephone | 801-569-9133
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Fax | 801-569-9103
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Provider Business Mailing Address
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Address Line | 1575 W 7000 S
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City | WEST JORDAN
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State | UT
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Zip | 84084-3431
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Country | US
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Telephone | 801-569-9133
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Fax | 801-569-9103
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Authorized Official
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Title or Position | MD / OWNER
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Name | RANDALL L WATSON
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Credential | MD
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Telephone | 801-569-9133
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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 | 1756991205
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License Number State | UT
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