Individual
GLENN O MORTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1750 N 1000 E, LOGAN, UT 84341-1909
(435) 757-1516
Mailing address
1750 N 1000 E, LOGAN, UT 84341-1909
(435) 757-1516
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1609171205
UT
Other
Enumeration date
08/08/2006
Last updated
02/19/2016
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