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Organization
PROVAS OF OGDEN, LLC
Active
Organization
PROVAS OF OGDEN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN HEWETT MD (MEDICAL DIRECTOR)
(801) 386-4896
Entity
Organization
Contact information
Practice address
5974 FASHION POINT DR STE 110, SOUTH OGDEN, UT 84403-4712
(801) 386-4896
Mailing address
5974 FASHION POINT DR STE 110, SOUTH OGDEN, UT 84403-4712
(801) 386-4896
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
NULL
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
—
Other
Enumeration date
05/24/2019
Last updated
05/24/2019
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