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General NPI Number Information
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NPI Number | 1427187582
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Entity Type | Organization
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Legal Business Name | CACHE VALLEY CANCER TREATMENT &RESEARCH CLINIC PC
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 11/03/2014
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Provider Practice Location Address
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Address Line | 1281 N 600 E
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City | LOGAN
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State | UT
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Zip | 84341-6988
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Country | US
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Telephone | 435-752-5999
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Fax | 435-752-5551
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Provider Business Mailing Address
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Address Line | 1281 N 600 E
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City | LOGAN
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State | UT
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Zip | 84341-6988
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Country | US
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Telephone | 435-752-5999
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Fax | 435-752-5551
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ALI BEN-JACOB
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Credential | M.D.
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Telephone | 435-752-5999
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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 | 292373-1205
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License Number State | UT
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