Individual
KATHERINE REBECCA LAVENDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
750 ROUND VALLEY DR, SUITE 102, PARK CITY, UT 84060-7548
(435) 655-0926
(435) 649-3748
Mailing address
7138 S 2000 E, SALT LAKE CITY, UT 84121-3757
(801) 453-9625
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
6360349-1205
UT
Other
Enumeration date
11/15/2007
Last updated
07/26/2013
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