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General NPI Number Information
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NPI Number | 1306840129
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Entity Type | Individual
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Provider Name | DAVID L WETZEL RPT
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Gender | Male
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 04/03/2023
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Provider Practice Location Address
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Address Line | 12403 S DOREEN DR
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City | RIVERTON
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State | UT
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Zip | 84065-4360
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Country | US
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Telephone | 801-448-1770
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Fax | 801-877-5356
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Provider Business Mailing Address
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Address Line | 12403 S DOREEN DR
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City | RIVERTON
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State | UT
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Zip | 84065-4360
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Country | US
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Telephone | 801-448-1770
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Fax | 801-877-5356
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 22-106687-2401
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License Number State | UT
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