Organization
PHASE II ST GEORGE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELIZABETH S GRAUL M.D. (OWNER)
(801) 502-9024
Entity
Organization
Contact information
Practice address
230 N 1680 E, BLDG I, ST GEORGE, UT 84790-2579
(435) 627-2978
Mailing address
230 N 1680 E, BLDG I, ST GEORGE, UT 84790-2579
(435) 627-2978
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
2751391205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000058012
MEDICARE GROUP ID NUMBER
UT
Enumeration date
11/02/2007
Last updated
04/13/2011
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