# MOUNTAIN WEST FAMILY PRACTICE LLC

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

## Provider details

- **NPI number:** 1770581605
- **Authorized official:** BLAKE BEAZER MD (PRESIDENT)
- **Authorized official phone:** (435) 882-2350

## Contact information

- **Practice address:** 2356 N 400 E, SUITE 201, TOOELE, UT 84074
- **Practice address phone:** (435) 882-2350
- **Practice address fax:** (435) 882-2039
- **Mailing address:** 2356 N 400 E, SUITE 201, TOOELE, UT 84074
- **Mailing address phone:** (435) 882-2350
- **Mailing address fax:** (435) 882-2039

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 2005172 | UT | Yes |

## Other

- **Enumeration date:** 07/13/2005
- **Last updated:** 11/24/2020