Individual
DR. RAYMOND JACK MIDDLETON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
653 SOUTH 170 WEST, IVINS, UT 84738
(435) 632-8628
(435) 634-1320
Mailing address
653 SOUTH 170 WEST, IVINS, UT 84738
(435) 632-8628
(435) 634-1320
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
161827-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05805
—
UT
05
—
870609622001
—
UT
Enumeration date
04/25/2006
Last updated
12/22/2016
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