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General NPI Number Information
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NPI Number | 1881067569
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC EVALUATION SERVICES, LLC
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Dates
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Enumeration Date | 11/04/2015
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Last Update Date | 11/04/2015
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Provider Practice Location Address
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Address Line | 385 N 500 W
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City | PROVO
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State | UT
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Zip | 84601-2681
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Country | US
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Telephone | 303-246-9879
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 271388
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City | LITTLETON
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State | CO
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Zip | 80127-0023
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. WILLIAM H QUTUB
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Credential | MD
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Telephone | 303-246-9879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 9357124-0151
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License Number State | UT
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