Individual
DR. EVAN J MATHESON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
745 N 500 W, #200, PROVO, UT 84601-1472
(801) 375-9292
Mailing address
745 N 500 W, #200, PROVO, UT 84601-1472
(801) 375-9292
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
1758051205
UT
207K00000X
Allergy & Immunology Physician
Primary
1758051205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0200019
UNITED HEALTHCARE
UT
01
—
107007559101
IHC
UT
01
—
841428839
ALTIUS
UT
Enumeration date
11/08/2005
Last updated
04/18/2019
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