Organization
DOUGLAS J LICHTI MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS J LICHTI MD (PRESIDENT)
(435) 657-2711
Entity
Organization
Contact information
Practice address
380 E 1500 S, STE 201, HEBER CITY, UT 84032-3940
(435) 657-2711
(435) 657-2716
Mailing address
380 E 1500 S, STE 201, HEBER CITY, UT 84032-3940
(435) 657-2711
(435) 657-2716
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
1835651205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10/27/1955
OWNERS DOB
—
Enumeration date
06/03/2013
Last updated
09/05/2013
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