| Joe R Nielsen Md Pc | |
|
415 Medical Dr D-200 Bountiful UT 84010-4946 | |
| (801) 292-6277 | |
| (801) 292-1108 |
| Full Name | Joe R Nielsen Md Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 415 Medical Dr, Bountiful, Utah |
| Authorized Official Name and Position | Joe R Nielsen (PRESIDENT) |
| Authorized Official Contact | 8012926277 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Joe R Nielsen Md Pc 415 Medical Dr D-200 Bountiful UT 84010-4946 Ph: (801) 292-6277 | Joe R Nielsen Md Pc 415 Medical Dr D-200 Bountiful UT 84010-4946 Ph: (801) 292-6277 |
| NPI Number | 1164723482 |
|---|---|
| Provider Enumeration Date | 11/03/2010 |
| Last Update Date | 11/03/2010 |
| Medicare PECOS PAC ID | 0244427136 |
|---|---|
| Medicare Enrollment ID | O20101203000879 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164723482 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 178171-1205 (Utah) | Primary |
| Provider Name | Joe Roth Nielsen |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1992766885 PECOS PAC ID: 1153518048 Enrollment ID: I20101203000963 |
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