Organization
INTERMOUNTAIN ALLERGY & IMMUNOLOGY CLINIC
Active
Other names
Intermountain Allergy & Asthma
Organization subpart
No
Provider details
NPI number
Authorized official
DUANE HARRIS (PARTNER)
(801) 363-4071
Entity
Organization
Contact information
Practice address
5929 FASHION POINT DR, STE 101, SOUTH OGDEN, UT 84403-4672
(801) 476-0052
(801) 476-0064
Mailing address
5929 FASHION POINT DR, STE 101, SOUTH OGDEN, UT 84403-4672
(801) 476-0052
(801) 476-0064
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA3060
GROUP RAILROAD MEDICARE
—
Enumeration date
09/06/2006
Last updated
01/11/2011
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