Organization
SYRACUSE FAMILY & OCCUPATIONAL MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD R HASTIE FNP--BC (OWNER / OPERATOR)
(801) 564-7091
Entity
Organization
Contact information
Practice address
1842 S 2000 W # 2, SYRACUSE, UT 84075-9626
(801) 774-7450
(801) 774-7452
Mailing address
1842 S 2000 W #2, SYRACUSE, UT 84075-9626
(801) 774-7450
(801) 774-7452
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
7994885-0162
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619900339
APRN NPI NUMBER
UT
01
—
204722-4405
UT LICENSE
UT
Enumeration date
07/01/2011
Last updated
07/01/2011
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