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Organization
DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM
Active
Organization
DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM
Active
Other names
Fort Duchesne Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DELBERT GARY MARTIN RPH (CHIEF PHARMACIST)
(435) 725-6874
Entity
Organization
Contact information
Practice address
6822 E 1000 SOUTH, FORT DUCHESNE, UT 84026
(435) 722-5122
Mailing address
6822 EAST 1000 SOUTH, FORT DUCHESNE, UT 84026
(435) 722-5122
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
122300000X
Dentist
—
—
163W00000X
Registered Nurse
—
—
207Q00000X
Family Medicine Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
213E00000X
Podiatrist
—
—
225100000X
Physical Therapist
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
700000000009
—
UT
Enumeration date
06/20/2008
Last updated
04/04/2013
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