Organization
GRANT AJ NEEDHAM PA CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AJ YERGENSEN MBA (ADMIN)
(435) 986-9369
Entity
Organization
Contact information
Practice address
1107 N CASITAS HILL LOOP, WASHINGTON, UT 84780-8922
(435) 632-7681
Mailing address
1107 N CASITAS HILL LOOP, WASHINGTON, UT 84780-8922
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
04/07/2026
Last updated
04/07/2026
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