MEDICARE: DR. KAREN M RADLEY M.D. PC

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	207Q00000X	Family Medicine Physician	Z67908	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DD8580	OTHER	UT	PALMETTO GBA-RAILROAD MEDICARE

General Provider Information

NPI Number	:	1508868563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN M RADLEY M.D. PC

Provider Business Mailing Address
First Line	:	965 E 700 S STE 300
Second Line	:
City	:	SAINT GEORGE
State	:	UT
Zip	:	84790-4086
Country	:	US
Telephone Number	:	435-673-4644
Fax Number	:	855-222-7622

Provider Business Practice Location Address
First Line	:	965 E 700 S STE 300
Second Line	:
City	:	SAINT GEORGE
State	:	UT
Zip	:	84790-4086
Country	:	US
Telephone Number	:	435-673-4644
Fax Number	:	855-222-7622

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	05/03/2019

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