Individual
ROGER TIMOTHY PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4088 US-91, HYDE PARK, UT 84318
(435) 563-4900
Mailing address
4088 US-91, HYDE PARK, UT 84318
(435) 563-4900
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
8647453-1204
UT
Other
Enumeration date
01/06/2006
Last updated
05/14/2021
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