MEDICARE: HUGO G. ALTAMIRANO MD LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1578759114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUGO G. ALTAMIRANO MD LLC

Provider Business Mailing Address
First Line	:	745 N 500 W # 200
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84601-1472
Country	:	US
Telephone Number	:	801-375-9292
Fax Number	:	801-375-9290

Provider Business Practice Location Address
First Line	:	745 N 500 W # 200
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84601-1472
Country	:	US
Telephone Number	:	801-375-9292
Fax Number	:	801-375-9290

Authorized Official
Title or Position	:	ASSOCIATE PHYSICIAN
Name	:	DR. HUGO G ALTAMIRANO
Credential	:	M.D.
Telephone Number	:	801-375-9292

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	01/24/2011

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