MEDICARE: DR. HUGO G ALTAMIRANO 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
1	174400000X	Specialist	50191281205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	107010628101	OTHER	UT	IHC
2	50191281200001	OTHER	UT	BLUE CROSS BLUE SHIELD
3	QM0000058767	OTHER	UT	ALTIUS
4	1200737	OTHER	UT	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1417938325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HUGO G ALTAMIRANO M.D.

Provider Business Mailing Address
First Line	:	745 N 500 W
Second Line	:	#200
City	:	PROVO
State	:	UT
Zip	:	84601-1472
Country	:	US
Telephone Number	:	801-375-9292
Fax Number	:

Provider Business Practice Location Address
First Line	:	745 N 500 W
Second Line	:	#200
City	:	PROVO
State	:	UT
Zip	:	84601-1472
Country	:	US
Telephone Number	:	801-375-9292
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	11/06/2007

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Directions to “ DR. HUGO G ALTAMIRANO M.D.” Practice Location

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