MEDICARE: DR. DAVID W NEMETZ MD

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	174816-1205	UT

General Provider Information

NPI Number	:	1811984800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID W NEMETZ MD

Provider Business Mailing Address
First Line	:	4650 HARRISON BLVD
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-4303
Country	:	US
Telephone Number	:	801-475-3000
Fax Number	:	801-475-3414

Provider Business Practice Location Address
First Line	:	1159 E 12TH ST
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84404-5144
Country	:	US
Telephone Number	:	801-475-3700
Fax Number	:	801-475-3701

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	10/31/2012

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