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General NPI Number Information
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NPI Number | 1356519656
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Entity Type | Organization
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Legal Business Name | ELK RIDGE FAMILY PRACTICE PC
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Dates
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Enumeration Date | 02/20/2008
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 1172 E 100 N STE 11
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City | PAYSON
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State | UT
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Zip | 84651-1668
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Country | US
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Telephone | 801-465-6100
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Fax | 801-465-6114
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Provider Business Mailing Address
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Address Line | 1172 E 100 N STE 11
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City | PAYSON
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State | UT
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Zip | 84651-1668
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Country | US
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Telephone | 801-465-6100
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Fax | 801-465-6114
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Authorized Official
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Title or Position | PRESIDENT
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Name | DENNIS MICHAEL CONCOBY
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Credential | D.O
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Telephone | 801-465-6100
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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 | 5656211-1204
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License Number State | UT
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