Organization
FORT DUCHESNE INDIAN HEALTH CENTER RADIOLOGY
Active
Other names
FORT DUCHESNE INDIAN HEALTH CENTER RADIOLOGY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DELBERT GARY MARTIN RPH (CHIEF PHARMACIST)
(435) 725-6874
Entity
Organization
Contact information
Practice address
6822 EAST 1000 SOUTH, FORT DUCHESNE, UT 84026
(435) 725-6874
(435) 725-6889
Mailing address
6822 EAST 1000 SOUTH, FORT DUCHESNE, UT 84026
(435) 725-6874
(435) 725-6889
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
700000000009
—
UT
Enumeration date
07/21/2009
Last updated
04/04/2013
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