# GOOD SHEPHERD MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710643549
- **Authorized official:** MR. NATHANIEL LEFEVOR MBA (ADMINISTRATOR)
- **Authorized official phone:** (801) 574-9566

## Contact information

- **Practice address:** 3584 W 9000 S STE 300, WEST JORDAN, UT 84088-5711
- **Practice address phone:** (801) 277-6474
- **Practice address fax:** (877) 789-0498
- **Mailing address:** 3584 W 9000 S STE 300, WEST JORDAN, UT 84088-5711
- **Mailing address phone:** (801) 277-6474
- **Mailing address fax:** (877) 789-0498

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/16/2021
- **Last updated:** 11/16/2021