Individual
DOUGLAS LAMAR FILLMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1055 N 500 W, SUITE 121, PROVO, UT 84604-3305
(801) 373-7350
(801) 812-5401
Mailing address
1055 N 500 W, CREDENTIALING DEPARTMENT, PROVO, UT 84604-3305
(801) 354-8215
(801) 429-8180
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4945215-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107012276106
IHC
UT
Enumeration date
09/27/2006
Last updated
10/15/2007
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