Individual
TRISHA RAFFERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4403 HARRISON BLVD, STE 4875, OGDEN, UT 84403-3271
(801) 387-4500
(801) 387-4712
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 387-4500
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
356022-1205
UT
208000000X
Pediatrics Physician
R70641
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720215478
—
UT
Enumeration date
06/19/2009
Last updated
09/22/2011
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