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General NPI Number Information
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NPI Number | 1225255094
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Entity Type | Organization
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Legal Business Name | UINTA EAR, NOSE & THROAT, PC
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 196 ARROWHEAD DR SUITE 5
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City | EVANSTON
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State | WY
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Zip | 82930-8752
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Country | US
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Telephone | 307-783-8364
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Fax |
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Provider Business Mailing Address
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Address Line | 196 ARROWHEAD DR SUITE 5
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City | EVANSTON
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State | WY
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Zip | 82930-8752
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Country | US
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Telephone | 307-783-8364
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID J HARBRECHT
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Credential |
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Telephone | 307-783-8364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 4309A
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License Number State | WY
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