MEDICARE: DR. ALEXANDER H HASKELL ND

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	175F00000X	Naturopath	6718543-7101	UT

General Provider Information

NPI Number	:	1619156114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER H HASKELL ND

Provider Business Mailing Address
First Line	:	1901 PROSPECTOR AVE
Second Line	:	STE. 30
City	:	PARK CITY
State	:	UT
Zip	:	84060-7207
Country	:	US
Telephone Number	:	435-658-0500
Fax Number	:	435-658-0520

Provider Business Practice Location Address
First Line	:	1901 PROSPECTOR AVE
Second Line	:	STE. 30
City	:	PARK CITY
State	:	UT
Zip	:	84060-7207
Country	:	US
Telephone Number	:	435-658-0500
Fax Number	:	435-658-0520

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

Provider Enumeration Date	:	10/31/2007
Last Update Date	:	10/31/2007

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