Individual
DR. FREDERIC M CIVISH III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3534 S 6000 W, WEST VALLEY, UT 84128-2610
(801) 969-6264
(801) 969-6333
Mailing address
3354 W 7800 S, WEST JORDAN, UT 84088-4506
(801) 282-2677
(801) 282-4654
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
184916-1205
UT
Other
Enumeration date
08/30/2006
Last updated
01/23/2017
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