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General NPI Number Information
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NPI Number | 1235783994
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Entity Type | Organization
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Legal Business Name | MOUNTAIN TOP MEDICAL, PLLC
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 07/30/2019
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Provider Practice Location Address
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Address Line | 140 E 1000 S STE B2
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City | BRIGHAM CITY
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State | UT
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Zip | 84302-4399
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Country | US
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Telephone | 435-515-3030
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Fax | 435-515-3434
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Provider Business Mailing Address
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Address Line | 140 E 1000 S STE B2
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City | BRIGHAM CITY
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State | UT
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Zip | 84302-4399
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Country | US
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Telephone | 435-515-3030
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Fax | 435-515-3434
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Authorized Official
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Title or Position | CO-OWNER
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Name | MICHAEL C SHAW
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Credential | MD
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Telephone | 435-515-3030
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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 |
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License Number State |
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