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1675 N Freedom Blvd Suite 3 Provo UT 84604-2540 | |
(801) 374-1010 | |
(801) 395-0097 |
Full Name | |
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Speciality | Internal Medicine |
Location | 1675 N Freedom Blvd, Provo, Utah |
Authorized Official Name and Position | Bret Woods (OWNER) |
Authorized Official Contact | 8014002050 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 50745 Provo UT 84605-0745 Ph: (801) 352-9500 | 1675 N Freedom Blvd Suite 3 Provo UT 84604-2540 Ph: (801) 374-1010 |
NPI Number | 1184847063 |
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Provider Enumeration Date | 04/10/2007 |
Last Update Date | 10/23/2007 |
Identifier | Type | State | Issuer |
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1184847063 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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