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NPI Code Detail

MEDICARE: PATRICE ANN DUVERNAY M.D.

MEDICARE: PATRICE ANN DUVERNAY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084N0400XNeurology Physician183098-1205UT

General Provider Information

NPI Number : 1073543872
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICE ANN DUVERNAY M.D.
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number : 801-535-8163
Fax Number : 801-355-4011
Provider Business Practice Location Address
First Line : 324 10TH AVE STE 200
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84103-2869
Country : US
Telephone Number : 801-408-7540
Fax Number : 801-408-2886
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2006
Last Update Date : 09/16/2011

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