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Organization
NORTHEASTERN UTAH MEDICAL GROUP
Active
Organization
NORTHEASTERN UTAH MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENT H HALES (CFO)
(435) 722-6164
Entity
Organization
Contact information
Practice address
210 W 300 N 7-3, ROOSEVELT, UT 84066
(435) 722-3971
(435) 722-6104
Mailing address
210 W 300 N, ROOSEVELT, UT 84066-2336
(435) 722-3971
(435) 722-6104
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
NULL
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
NULL
207V00000X
Obstetrics & Gynecology Physician
—
—
207W00000X
Ophthalmology Physician
—
NULL
207W00000X
Ophthalmology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
NULL
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
—
NULL
207Y00000X
Otolaryngology Physician
—
—
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
—
NULL
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
—
—
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
Other
Enumeration date
03/23/2006
Last updated
10/23/2025
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