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General NPI Number Information
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NPI Number | 1316991565
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Entity Type | Individual
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Provider Name | BEVERLY L VARGO M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1912 W 930 N
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-4104
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Country | US
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Telephone | 801-492-1999
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Fax | 801-492-1991
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Provider Business Mailing Address
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Address Line | 3467 EASTWOOD DR
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City | SALT LAKE CITY
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State | UT
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Zip | 84109-3207
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Country | US
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Telephone | 801-492-1999
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Fax | 801-492-1991
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2797364-1205
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License Number State | UT
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